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.

Cryptosporidiosis

Last Updated: July 16, 2019; Last Reviewed: July 16, 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:

  • 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), and
  • Initiation or optimization of ART for immune restoration to CD4 count >100 cells/mm3 (AII)

Consider:

  • Nitazoxanide 500 mg to 1,000 mg PO twice daily with food for 14 days (CIII) plus optimized ART, symptomatic treatment, and rehydration and electrolyte replacement, or
  • Paromomycin 500 mg PO four times a day for 14 days–21 days (CIII) plus optimized ART, symptomatic treatment, and rehydration and electrolyte replacement

Other Considerations

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

Key: ART = antiretroviral therapy; CD4 = CD4 T lymphocyte cell; IV = intravenous; PO = orally

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