Strategies for managing
opportunistic infections

May 2008     View PDF     En español

Preventive treatment for OIs

OIs are generally not a problem for people whose CD4 cell counts remain stable above 200. It is extremely rare for people living with HIV to die of AIDS when their CD4 counts are above 200. However, as CD4 counts decline your risk for getting OIs increases.

Perhaps the best strategy for preventing OIs is to keep your CD4 counts above 200. Therefore, the Federal Guidelines for using HIV therapy recommend that people consider starting HIV therapy when their CD4 counts are 350 or below. They also strongly recommend treating anyone with symptoms of HIV disease (regardless of CD4 counts) and anyone with CD4 counts of 200 or below. This is because HIV therapy stops HIV from destroying immune cells, preventing the further decline of the immune system.

There are also Federal Guidelines for preventing and treating HIV-related OIs. A summary of these guidelines is available in Project Inform’s publication, Opportunistic Infections Chart.

In general, if CD4 counts fall to 200 or below (or CD4 percentage below 14%), people are at increased risk for PCP. Preventive
therapy is advised. For people with other symptoms of HIV infection, especially repeated fungal (candida) infections, PCP
preventive therapy is often started when CD4 counts are higher, around 300. If CD4 counts fall to the 100–150 range, preventive therapy for toxoplasmosis is recommended for people who are
positive for it. If CD4 counts fall to 50 or below, preventive therapy for MAC and CMV is advised. For people who suspect they’ve been exposed to tuberculosis, pre­ventive therapy is warranted.