Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.


Last Updated: June 14, 2013; Last Reviewed: March 13, 2019

Recommendations for Preventing and Managing Cryptosporidiosis

Preventing Chronic Cryptosporidiosis

  • Because chronic cryptosporidiosis occurs primarily in persons with advanced immunodeficiency, initiation of ART before the patient becomes severely immunosuppressed should prevent the disease (AII).

Managing Cryptosporidiosis

Preferred Management Strategies:

  • Initiate or optimize ART for immune restoration to CD4 count >100 cells/mm3 (AII).
  • Aggressive oral and/or IV rehydration and replacement of electrolyte loss (AIII), and symptomatic treatment of diarrhea with anti-motility agent (AIII).
  • Tincture of opium may be more effective than loperamide (CIII).

Alternative Management Strategies:

No therapy has been shown to be effective without ART. Trial of these agents may be used in conjunction with, but not instead of, ART:

  • Nitazoxanide 500–1000 mg PO BID with food for 14 days (CIII) + optimized ART, symptomatic treatment, and rehydration and electrolyte replacement, or alternatively
  • Paromomycin 500 mg PO QID for 14 to 21 days (CIII) + optimized ART, symptomatic treatment and rehydration and electrolyte replacement

Other Considerations:

  • Since diarrhea can cause lactase deficiency, patients should avoid milk products (CIII).

Key to Acronyms: ART = antiretroviral therapy; IV = intraveneously; PO = orally; BID = twice a day; QID = four times a day

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