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.

Geographic Opportunistic Infections of Specific Consideration

Penicilliosis marneffei

Last Updated: May 7, 2013; Last Reviewed: September 13, 2017

Recommendations for Preventing and Treating Penicillium marneffei Infection
Preventing 1st Episode of Penicilliosis (Primary Prophylaxis)

Indication for Primary Prophylaxis: 
  • Patients with CD4 count <100 cells/mm3 who reside or stay for a long period in northern Thailand, Vietnam, and Southern China, in particular in rural areas (BI)
Preferred Therapy:
  • Itraconazolea 200 mg PO once daily (BI)
Alternative Therapy:
  • Fluconazole 400 mg PO once weekly (BII)
Indication for Discontinuing Primary Prophylaxis:
  • CD4 count >100 cells/mm3 for ≥6 months in response to ART (CII)
Indication for Restarting Primary Prophylaxis:
  • CD4 count decreases to <100 cells/mm3 (BIII
Treating Acute Infection in Severely Ill Patients

Preferred Therapy:
  • Liposomal amphotericin B, 3 to 5 mg/kg/day IV for 2 weeks; followed by itraconazolea 200 mg PO BID for 10 weeks (AII), followed by chronic maintenance therapy (AII)
Alternative Therapy:
  • Voriconazolea 6 mg/kg IV q12h for 1 day, then 4 mg/kg q12h for at least 3 days, followed by voriconazolea 200 mg PO BID for a maximum of 12 weeks (BII), followed by chronic maintenance therapy (BII)
Treating Mild Disease

Preferred Therapy:
  • Itraconazolea 200 mg PO BID for 8 weeks (BII), followed by chronic maintenance therapy. (BII)
Alternative Therapy:
  • Voriconazolea 400 mg PO BID for 1 day, then 200 mg BID for a maximum of 12 weeks (BII), followed by chronic maintenance therapy. (BII)
Chronic Maintenance Therapy (Secondary Prophylaxis)
  • Itraconazolea 200 mg PO daily (AI)
Criteria for Discontinuing Chronic Maintenance Therapy:
  • CD4 count >100 cells/mm3 for ≥6 months in response to ART (BII)
Criteria for Restarting Chronic Maintenance Therapy:
  • CD4 count <100 cells/mm3 (AIII), or
  • If penicilliosis recurs at CD4 count >100 cells/mm3 (CIII)
Other Considerations:
  • ART should be administered simultaneously with treatment for penicilliosis to improve outcome. (CIII)
  • Because of the erratic absorption and potential for drug interactions with ARV therapy, itraconazole concentration should be monitored, and serum concentration should be > 1 mcg/mL.
a Both itraconazole and voriconazole can have significant drug-drug interactions with various ARV drugs, dosage adjustment may be necessary, consider therapeutic drug monitoring to guide therapy. See Table 5 for drug interaction information

Key to Acronyms: CD4 = CD4 T lymphocyte; PO = orally; IV = intravenous; q(n)h = every “n” hours; BID = twice daily; ART = antiretroviral therapy, ARV = antriretroviral

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