Preventive interventions for patients with HIV in resource-limited settings

This algorithm reflects WHO recommendations for antiretroviral initiation and prophylactic interventions for patients with HIV infection in resource-limited settings.^[1,2] Other general preventive measures, such as deworming and nutritional supplementation, are not covered here. Refer to other UpToDate content for details.

ART: antiretroviral therapy; HIV: human immunodeficiency virus; INH: isoniazid; TB: tuberculosis; TMP-SMX: trimethoprim-sulfamethoxazole (cotrimoxazole); WHO: World Health Organization.

* WHO also recommends consideration of pre-ART cryptococcal screening and preemptive therapy for patients with CD4 cell count ≥100 but <200 cells/microL.

¶ For more details of evaluating for and treating cryptococcal meningitis, refer to other UpToDate content on treatment and prevention of cryptococcal meningitis in patients with HIV infection.

Δ Refer to other UpToDate content about WHO-recommended ART regimens.

◊ WHO clinical stage 3 or 4 disease includes unexplained weight loss, chronic diarrhea, persistent cytopenias or persistent fever; persistent oral or esophageal candidiasis; severe bacterial infections; and opportunistic infections or conditions. Refer to other UpToDate content for details.

§ A fixed-dose combination tablet of TMP-SMX, isoniazid, and pyridoxine is available in some locations.

References:

Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach, World Health Organization 2021. https://www.who.int/publications/i/item/9789240031593 (Accessed on July 30, 2024).
Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents, and children, World Health Organization 2018. https://www.who.int/publications/i/item/9789241550277 (Accessed on July 30, 2024).

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Preventive interventions for patients with HIV in resource-limited settings