A 29-year-old man is diagnosed with HIV infection. Baseline CD4 count is 190 cells/μL and he has no cough, fever, or breathlessness. Chest radiograph is normal. In addition to starting antiretroviral therapy, what should be prescribed now?
- A Azithromycin weekly
- B Trimethoprim-sulfamethoxazole daily ✓
- C Isoniazid preventive therapy for 6 months
- D Fluconazole weekly
Correct answer: B. Trimethoprim-sulfamethoxazole daily
Explanation
Primary Pneumocystis jirovecii prophylaxis with trimethoprim-sulfamethoxazole is indicated once the CD4 count falls below 200 cells/μL, and it also gives protection against toxoplasmosis. Azithromycin prophylaxis against Mycobacterium avium complex starts below 50 cells/μL, fluconazole prophylaxis is not routinely given, and isoniazid preventive therapy depends on latent TB screening rather than this CD4 threshold.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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