Opportunistic Infections in HIV Infected Patients

Oral Candidiasis:

-Fluconazole (Diflucan) acute: 100-200 mg PO qd OR -Ketoconazole (Nizoral), acute: 400 mg PO qd OR -Itraconazole (Sporanox) 200 mg PO qd OR

-Clotrimazole (Mycelex) troches 10 mg dissolved slowly in mouth 5 times/d. Candida Esophagitis:

-Fluconazole (Diflucan) 200-400 mg PO qd for 14-21 days OR -Ketoconazole (Nizoral) 200 mg PO bid. -Itraconazole (Sporanox) 200 mg PO qd for 2 weeks.

Primary or Recurrent Mucocutaneous HSV

-Acyclovir (Zovirax), 200-400 mg PO 5 times a day for 10 days, or 5 mg/kg IV q8h OR in cases of acyclovir resistance, foscarnet, 40 mg/kg IV q8h for 21 days.

Herpes Simplex Encephalitis (or visceral disease):

-Acyclovir 10 mg/kg IV q8h for 10-21 days. Herpes Varicella Zoster

-Acyclovir 10 mg/kg IV over 60 min q8h for 7-14 days OR 800 mg PO 5

times/d for 7-10 days OR -Famciclovir (Famvir) 500 mg PO q8h for 7 days [500 mg] OR -Valacyclovir (Valtrex) 1000 mg PO q8h for 7 days [500 mg] OR -Foscarnet (Foscavir) 40 mg/kg IV q8h. Cytomegalovirus Retinitis:

-Ganciclovir (Cytovene) 5 mg/kg IV (dilute in 100 mL D5W over 60 min) q12h for 14-21 days OR -Foscarnet (Foscavir) 60 mg/kg IV q8h for 2-3 weeks OR -Cidofovir (Vistide) 5 mg/kg IV over 60 min q week for 2 weeks. Administer probenecid, 2 g PO 3 hours prior to cidofovir, 1 g PO 2 hours after, and 1 g PO 8 hours after. Suppressive Treatment for Cytomegalovirus Retinitis: -Ganciclovir 5 mg/kg qd. -Foscarnet (Foscavir) 90-120 mg IV qd OR

-Cidofovir (Vistide) 5 mg/kg IV over 60 min every 2 weeks with probenecid. Acute Toxoplasmosis:

-Pyrimethamine 200 mg, then 50-75 mg qd, plus sulfadiazine 1.0-1.5 gm PO

q6h, plus folinic acid 10 mg PO qd OR -Atovaquone (Mepron) 750 mg PO tid.

Suppressive Treatment for Toxoplasmosis:

-Pyrimethamine 25-50 mg PO qd plus sulfadiazine 0.5-1.0 gm PO q6h plus folinic acid 5 mg PO qd OR

-Pyrimethamine 50 mg PO qd, plus clindamycin 300 mg PO qid, plus folinic acid 5 mg PO qd.

Cryptococcus Neoformans Meningitis:

-Amphotericin B 0.7-1.0 mg/kg/d IV; total dosage of 2 g, with or without 5-flucytosine 100 mg/kg PO qd in divided doses, followed by fluconazole (Diflucan) 400 mg PO qd or itraconazole (Sporanox) 200 mg PO bid 6-8 weeks

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