What prophylaxis is commonly used when CD4 count drops below 200 cells/mm3?

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Multiple Choice

What prophylaxis is commonly used when CD4 count drops below 200 cells/mm3?

Explanation:
When the CD4 count drops below 200 cells/mm3, the immune system becomes especially vulnerable to Pneumocystis jirovecii pneumonia (PCP). The prophylaxis most commonly used at this threshold is trimethoprim-sulfamethoxazole because it effectively prevents PCP and also offers protection against toxoplasmosis in seropositive patients, making it the first-line choice for PCP prevention. If TMP-SMX cannot be used due to allergy or intolerance, alternatives such as dapsone, atovaquone, or pentamidine can be considered. Azithromycin is typically used to prevent Mycobacterium avium complex when CD4 is very low, and fluconazole is used to prevent fungal infections like candidiasis rather than PCP.

When the CD4 count drops below 200 cells/mm3, the immune system becomes especially vulnerable to Pneumocystis jirovecii pneumonia (PCP). The prophylaxis most commonly used at this threshold is trimethoprim-sulfamethoxazole because it effectively prevents PCP and also offers protection against toxoplasmosis in seropositive patients, making it the first-line choice for PCP prevention. If TMP-SMX cannot be used due to allergy or intolerance, alternatives such as dapsone, atovaquone, or pentamidine can be considered. Azithromycin is typically used to prevent Mycobacterium avium complex when CD4 is very low, and fluconazole is used to prevent fungal infections like candidiasis rather than PCP.

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