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, 2019; Last Reviewed: June 26, 2019

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 GI 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 are effective, but neither agent is available in the United States.
  • Nitazoxanide can have a therapeutic effect, but this efficacy has been limited in patients with low CD4 cell counts (CIII).

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

  • Albendazole 400 mg PO twice daily (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 plus albendazole 400 mg PO two times a day (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 four times daily (investigational use only in United States) (BII), plus albendazole 400 mg PO twice daily 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/mm3 for ≥6 months in response to ART (BIII).

Key: ART = antiretroviral therapy; CD4 = CD4 T lymphocyte; GI = gastrointestinal; PO = orally

Download Guidelines