HIV Patient with Suspected OI
New infection in patient with HIV, especially if CD4 <200
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Infectious DiseaseManagement
HIV Opportunistic Infections Management
HIV Opportunistic Infections Management: HIV Patient with Suspected OI → Check CD4 Count & Viral Load → Opportunistic Infection Type → PCP (Pneumocystis...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Check CD4 Count & Viral Load
Guides differential
- CD4 <200: PCP, toxo, crypto, MAC, CMV, HSV, candida
- CD4 <100: CMV, MAC, crypto higher risk
- CD4 <50: Disseminated MAC, CMV retinitis
03Decision Opportunistic Infection Type
Based on presentation
04Action PCP (Pneumocystis)
Dyspnea, dry cough, hypoxia, bilateral infiltrates
- TMP-SMX 15-20mg/kg/day TMP divided q6-8h x21 days
- Alternative: Pentamidine IV, Primaquine + Clindamycin
- Steroids if PaO2 <70 or A-a gradient >35
- Start ART within 2 weeks
05Action ART Initiation Timing
Critical decision
- Most OIs: Start ART within 2 weeks
- Cryptococcal meningitis: Delay 4-6 weeks
- TB meningitis: Consider delay 2-8 weeks
- Watch for IRIS (immune reconstitution syndrome)
06Action Primary/Secondary Prophylaxis
Based on CD4 count
- CD4 <200: TMP-SMX for PCP + toxo
- CD4 <100: Consider Fluconazole for crypto
- CD4 <50: Azithromycin for MAC
- Discontinue when CD4 >100-200 on ART x3-6 months
07Outcome OI Resolved
Complete treatment, maintain prophylaxis
08Warning IRIS / Treatment Failure
Worsening after ART start or persistent OI
- IRIS: Steroids may help, continue ART
- Treatment failure: Drug resistance, poor adherence
09Action Cryptococcal Meningitis
Headache, fever, altered mental status
- Induction: Ampho B + Flucytosine x2 weeks
- Consolidation: Fluconazole 400mg/day x8 weeks
- Maintenance: Fluconazole 200mg/day
- LP for opening pressure - serial LPs if elevated
- Delay ART 4-6 weeks (reduce IRIS risk)
- Path rejoins step 05Shared downstream outcome
10Action Toxoplasmosis
Ring-enhancing brain lesions, focal neuro deficits
- Pyrimethamine 200mg load, then 50-75mg/day
- + Sulfadiazine 1-1.5g QID + Leucovorin 10-25mg/day
- Duration: 6+ weeks, then maintenance
- Alternative: TMP-SMX high dose
- Path rejoins step 05Shared downstream outcome
11Action CMV Disease
Retinitis, colitis, esophagitis
- Retinitis: Ganciclovir IV or Valganciclovir PO
- Colitis: Ganciclovir IV x21-42 days
- Maintenance until immune reconstitution
- Ophthalmology for retinitis monitoring
- Path rejoins step 05Shared downstream outcome
12Action MAC (Mycobacterium avium)
Fever, weight loss, anemia, LN, hepatosplenomegaly
- Clarithromycin 500mg BID + Ethambutol 15mg/kg/day
- Consider adding Rifabutin (not rifampin with ART)
- Duration: Minimum 12 months + immune reconstitution
- Start ART within 2 weeks
- Path rejoins step 05Shared downstream outcome
13Action Candidiasis
Oropharyngeal or esophageal
- Oral: Fluconazole 100-200mg/day x7-14d
- Esophageal: Fluconazole 200-400mg/day x14-21d
- Refractory: Posaconazole, Echinocandin, Ampho B
- Path rejoins step 05Shared downstream outcome
Guideline Source
NIH/CDC/HIVMA Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- ⚠️ UNVALIDATED DRAFT: This algorithm was AI-generated from guideline summaries and has NOT been reviewed by clinical experts. All doses, thresholds, and pathways MUST be verified against primary sources by qualified clinicians before clinical use. Do not use for patient care without expert validation.
- ART initiation timing varies by OI
- IRIS is common
- Prophylaxis thresholds by CD4 count
- Drug interactions with ART
Applicable Regions
USEU
Version 1Next review: 2027-01-11
Next steps
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Related Resources
Frequently Asked Questions
What is the HIV Opportunistic Infections Management?
The HIV Opportunistic Infections Management is a management clinical algorithm for Infectious Disease. It provides a structured decision tree to guide clinical decision-making, based on NIH/CDC/HIVMA Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV.
What guideline is the HIV Opportunistic Infections Management based on?
This algorithm is based on NIH/CDC/HIVMA Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV.
What are the limitations of the HIV Opportunistic Infections Management?
Known limitations include: ⚠️ UNVALIDATED DRAFT: This algorithm was AI-generated from guideline summaries and has NOT been reviewed by clinical experts. All doses, thresholds, and pathways MUST be verified against primary sources by qualified clinicians before clinical use. Do not use for patient care without expert validation.; ART initiation timing varies by OI; IRIS is common; Prophylaxis thresholds by CD4 count; Drug interactions with ART. Individual patient factors may require deviation from these recommendations.
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