An asymptomatic HIV-positive adult is found to have a CD4 count of 160 cells/μL. He has no cough, fever, or breathlessness. Which intervention is indicated at this threshold?
- A Start azithromycin weekly for Mycobacterium avium complex prophylaxis
- B Start fluconazole suppressive therapy for Cryptococcus neoformans
- C Start trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis jirovecii pneumonia ✓
- D Defer all prophylaxis until the CD4 count falls below 100 cells/μL
Correct answer: C. Start trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis jirovecii pneumonia
Explanation
Primary prophylaxis against Pneumocystis jirovecii pneumonia is indicated once the CD4 count falls below 200 cells/μL, and the agent of choice is trimethoprim-sulfamethoxazole double strength daily, which also protects against toxoplasmosis. Azithromycin for MAC prophylaxis is reserved for CD4 below 50 cells/μL, and routine fungal prophylaxis is not recommended. This patient qualifies because his count is 160.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.