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

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.

Microsporidiosis

Last Updated: May 7, 2013; Last Reviewed: June 14, 2017

Recommendations for Managing Microsporidiosis

Preventing Chronic Microsporidiosis

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

Managing Microsporidiosis

  • Initiate or optimize ART with immune restoration to CD4 count >100 cells/mm3 (AII).
  • Severe dehydration, malnutrition, and wasting should be managed by fluid support (AII) and nutritional supplements (AIII).
  • Anti-motility agents can be used for diarrhea control, if required (BIII).

For Gastrointestinal Infections Caused by Enterocytozoon bieneusi

  • The best treatment option is ART and fluid support (AII).
  • No specific therapeutic agent is available for this infection.
  • Fumagillin 60 mg PO daily (BII) and TNP-470 (BIII) are two agents that have some effectiveness, but neither agent is available in the United States.
  • Nitazoxanide may have some effect, but the efficacy is minimal in patients with low CD4 cell count (CIII).

For Intestinal and Disseminated (Not Ocular) Infection Caused by Microsporidia Other Than E. bieneusi and Vittaforma corneae

  • Albendazole 400 mg PO BID (AII), continue until CD4 count >200 cells/mm3 for >6 months after initiation of ART (BIII)

For Disseminated Disease Caused by Trachipleistophora or Anncaliia

  • Itraconazole 400 mg PO daily + albendazole 400 mg PO BID (CIII)

For Ocular Infection:

  • Topical fumagillin bicylohexylammonium (Fumidil B) 3 mg/mL in saline (fumagillin 70 µg/mL) eye drops—2 drops every 2 hours for 4 days, then 2 drops QID (investigational use only in United States) (BII), plus albendazole 400 mg PO BID for management of systemic infection (BIII)
  • For patients with CD4 count >200 cells/mm3, therapy can probably be discontinued after ocular infection resolves (CIII).
  • For patients with CD4 count ≤200 cells/mm3, therapy should be continued until resolution of ocular symptoms and CD4 count increases to >200 cells/uL for at least 6 months in response to ART (BIII)
Key to Acronyms: ART = antiretroviral therapy; BID = twice daily; PO = orally, QID = four times daily

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