A 34-year-old woman with HIV has a CD4 count of 110 cells/μL and is not on ART. She is currently asymptomatic with no opportunistic infections. According to current guidelines, which opportunistic infection prophylaxis should be initiated at this CD4 threshold?
- A Mycobacterium avium complex (MAC) prophylaxis with azithromycin
- B Toxoplasma gondii prophylaxis with pyrimethamine plus sulfadiazine
- C Pneumocystis jirovecii pneumonia (PCP) prophylaxis with trimethoprim-sulfamethoxazole ✓
- D Cryptococcal meningitis prophylaxis with fluconazole
Correct answer: C. Pneumocystis jirovecii pneumonia (PCP) prophylaxis with trimethoprim-sulfamethoxazole
Explanation
PCP prophylaxis is recommended when CD4 count falls below 200 cells/μL. Trimethoprim-sulfamethoxazole (TMP-SMX) is the agent of choice. MAC prophylaxis is indicated when CD4 drops below 50 cells/μL. Toxoplasma prophylaxis is for IgG-positive patients with CD4 below 100 cells/μL, often covered by the same TMP-SMX used for PCP. Routine antifungal prophylaxis for cryptococcasis is not recommended.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.