Primary prophylaxis in adults with HIV infection

Primary prophylaxis is indicated for selected patients at risk of Mycobacterium avium complex (MAC) infection, Pneumocystis jirovecii pneumonia (PJP) and Toxoplasma gondii encephalitis—see Primary prophylaxis for opportunistic infections in adults with HIV infection. Antimicrobial therapy to prevent other opportunistic infections is not recommended, except for patients at risk of tuberculosis reactivation (see Tuberculosis in adults with HIV infection).

Table 1. Primary prophylaxis for opportunistic infections in adults with HIV infection
Pathogen	When to start primary prophylaxis	Primary prophylaxis regimen
Mycobacterium avium complex (MAC)	CD4 count less than 50 cells/microlitre Ensure the patient does not have active MAC infection before starting prophylaxis.	See here for details.
Pneumocystis jirovecii	CD4 count less than 200 cells/microlitre, or CD4 cell percentage less than 14%	See here for details. If prophylaxis against both PJP and T. gondii is required, use the primary prophylaxis regimens for T. gondii encephalitis.
Toxoplasma gondii	CD4 count less than 100 cells/microlitre and T. gondii IgG antibody detected	See here for details. These regimens provide prophylaxis against both PJP and T. gondii.