Table 1.
Recommended prophylaxis regimens for renal transplantation candidates with HIV
| Condition | Primary prophylaxis* | Secondary prophylaxis‡ |
|---|---|---|
| Pneumocystis carinii pneumonia | Indicated for life; to be initiated immediately upon inclusion in transplantation list Preferred treatment: Trimethoprim-sulfamethoxazole Alternatives: Dapsone—if not glucose-6-phosphate dehydrogenase-deficient— or Atovaquone |
Same as for primary prophylaxis |
| Toxoplasmosis | Indicated with positive toxoplasmosis immunoglobulin G and CD4+ T-cell counts ≤200/ml Preferred treatment: Trimethoprim-sulfamethoxazole Alternatives: Atovaquone or sulfadiazine + pyrimethamine + leucovorin Discontinue with CD4+ T-cell >200/ml for 3–6 consecutive months |
Indicated with CD4+ T-cell counts ≤200/ml Treatment: Sulfadiazine + pyrimethamine + leucovorin Discontinue with CD4+ T-cell >200/ml for 3–6 consecutive months§ |
| Mycobacterium avium complex | Indicated when CD4+ T-cell counts ≤50/ml Preferred treatment: Azithromycin 1200 mg/week Alternative: Clarithromycin Discontinue with CD4+ T-cell count >100/ml for 3–6 consecutive months |
Indicated with CD4+ T-cell counts ≤50/ml Treatment: Clarithromycin + ethambutol Discontinue with CD4+ T-cell count>100/ml for 3–6 consecutive months |
| Cytomegalovirus | No HIV-specific indication | Indicated with CD4+ T-cell counts <75–100/ml Preferred treatment: Valganciclovir Alternatives: Foscarnet or cidofovir Discontinue with CD4+ T-cell counts >200/mL for 3–6 consecutive months§ |
| Extrapulmonary cryptococcus infection | No HIV-specific indication | Indicated with CD4+ T-cell counts <200/ml Treatment: Fluconazole Discontinue with CD4+ T-cell counts >200 for 3–6 consecutive months |
| Histoplasmosis | No HIV-specific indication | Indicated for life regardless of CD4+ T-cell count Treatment: Itraconazole |
*
No history of infection. Additional alternatives, drug interactions and dosing in renal insufficiency are available elsewhere.81
‡
Prior history of the infection. Additional alternatives, drug interactions and dosing in renal insufficiency are available elsewhere.81
§
Secondary prophylaxis should also be reinstituted immediately post-transplantation for one month and during the treatment of acute rejection for one month following completion of the rejection therapy. If CD4+ T-cell count is suppressed, continuation should be guided by the CD4+ T-cell count.