An asymptomatic HIV-positive man is found to have a CD4 count of 180 cells/μL on routine follow-up. He has never had an opportunistic infection and is not allergic to sulfonamides. What is the most appropriate intervention at this visit?
- A Start cotrimoxazole prophylaxis against Pneumocystis jirovecii pneumonia ✓
- B Start primary prophylaxis against Mycobacterium avium complex
- C Start fluconazole suppressive therapy against candidiasis
- D Recheck the CD4 count in 3 months before starting any prophylaxis
Correct answer: A. Start cotrimoxazole prophylaxis against Pneumocystis jirovecii pneumonia
Explanation
Primary prophylaxis against Pneumocystis jirovecii pneumonia is indicated when CD4 count falls below 200 cells/μL, and cotrimoxazole (TMP-SMX) is the agent of choice. It can be safely started even before ART initiation. MAC prophylaxis begins only below 50 cells/μL, and routine fungal suppression is not recommended because of resistance and drug interactions. Deferring until a lower count risks a first episode of PCP, which carries substantial mortality.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.