Table 2.

Opportunistic infection prophylaxis for HIV-infected transplant recipients

Opportunistic infection	Preferred agent	Primary prophylaxis *	Secondary prophylaxis **
Pneumocystis jiroveci	Trimethoprim-Sufamethoxazole	Indicated for life; initiate immediately post-transplant	Indicated for life; initiate immediately post-transplant
	Alternatives: dapsone if not G6PD deficient, atovaquone
Toxoplasmosis	Trimethoprim-Sulfamethoxazole	Toxoplasmosis IgG-positive patients with CD4 T-cell count ≤200 cells/mm3	CD4 T-cell count <200 cells/mm3
	Alternatives: atovaquine, sufadiazine + pyrimethamine + leucovorin		Discontinue when CD4+ T-cell count is >200 cells/mm3 for 3–6 months†
Mycobacterium avium complex	Azithromycin	CD4+ T-cell count ≤50 cells/mm3	CD4+ T-cell count <50 cells/mm3
	Alternatives: clarithromycin	Discontinue when CD4+ T-cell count >100 cells/mm3 for 3–6 months	Discontinue when CD4+ T-cell count is >100 cells/mm3 for 3–6 months†
Cytomegalovirus	Valganciclovir	No HIV specific indication	CD4 T-cell count <75–100 cells/mm3
	Alternatives: foscarnet, cidofovir		Discontinue when CD4+ T-cell count is >100–200 cells/mm3 for 3–6 months†
Cryptococcosis, extrapulmonary	Fluconazole	No HIV specific indication	CD4 T-cell count <200 cells/mm3
			Discontinue when CD4+ T-cell count is >200 cells/mm3 for 3–6 months†

^*No history of infection

^**Prior history of the infection

^†Secondary prophylaxis should also be reinstituted immediately post-transplant for 1 month and during the treatment of acute rejection for 1 month following completion of acute rejection therapy. If the CD4+ T-cell count is suppressed, continuation should be guided by the CD4+ T-cell count.