A 29-year-old man with newly diagnosed HIV has a CD4 count of 165 cells/μL. He is asymptomatic and about to start ART. Which additional intervention is indicated now?
- A Azithromycin weekly for Mycobacterium avium complex prophylaxis
- B Trimethoprim-sulfamethoxazole daily for Pneumocystis prophylaxis ✓
- C Fluconazole weekly for cryptococcal prophylaxis
- D Isoniazid preventive therapy regardless of tuberculin status
Correct answer: B. Trimethoprim-sulfamethoxazole daily for Pneumocystis prophylaxis
Explanation
Primary prophylaxis against Pneumocystis jirovecii pneumonia is indicated when the CD4 count falls below 200 cells/μL, and trimethoprim-sulfamethoxazole is the agent of choice because it also protects against toxoplasmosis. Azithromycin for MAC prophylaxis is reserved for CD4 below 50 cells/μL, and cryptococcal prophylaxis is not routinely recommended outside select settings. Isoniazid preventive therapy requires evidence of latent TB infection or exposure.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.