How to use this tool: Enter the CD4 count, WHO stage and current prophylaxis. The tool returns the opportunistic infection prophylaxis due, including co-trimoxazole and isoniazid preventive therapy, with the screening required before each is started.
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1. Current Disease Status
2. Prior OI History
OI Prophylaxis Plan1. Drug Pearls
OI Prophylaxis Quick Reference
Prophylaxis
Start When
Drug & Dose
Stop When
Cotrimoxazole
CD4 < 200 or WHO Stage 3/4
TMP-SMX 960mg (DS) OD
CD4 > 200 for ≥ 6 months on ART
IPT (Isoniazid)
All PLHIV after excluding active TB
INH 300mg + Pyridoxine 25mg OD x 6 months
After completing 6-month course
Fluconazole
After treated Cryptococcal disease
200mg OD (secondary prophylaxis)
CD4 > 200 for ≥ 6 months on ART
CrAg Screening
CD4 < 100 (before ART)
Serum CrAg lateral flow assay
If CrAg+: LP to exclude meningitis; pre-emptive Fluconazole
1. IPT: Key Safety Points
Symptom screen before IPT: Ask about cough > 2 weeks, fever, weight loss, night sweats. If ANY positive, do GeneXpert before starting IPT. Starting IPT with undiagnosed active TB leads to INH monotherapy and rapid resistance.
INH hepatotoxicity: Risk increases with age > 35, alcohol use, and pre-existing liver disease. Monitor ALT at baseline and monthly for the first 3 months. Stop if ALT > 3x ULN with symptoms or > 5x ULN without symptoms.
Peripheral neuropathy: INH depletes pyridoxine (vitamin B6). Always co-prescribe Pyridoxine 25mg OD to prevent peripheral neuropathy.
Abbreviations:ACE (Angiotensin-Converting Enzyme) · ALT (Alanine Aminotransferase) · ARB (Angiotensin Receptor Blocker) · ART (Antiretroviral Therapy) · ATT (Anti-Tubercular Therapy) · CD4 (Cluster of Differentiation 4) · CPT (Cotrimoxazole Preventive Therapy) · CrAg (Cryptococcal Antigen) · CXR (Chest X-Ray) · CYP (Cytochrome P450) · DS (Double Strength) · ECG (Electrocardiogram) · ENaC (Epithelial Sodium Channel) · G6PD (Glucose-6-Phosphate Dehydrogenase) · GFR (Glomerular Filtration Rate) · HIV (Human Immunodeficiency Virus) · IgG (Immunoglobulin G) · INH (Isoniazid) · IPT (Isoniazid Preventive Therapy) · LFT (Liver Function Test) · LP (Lumbar Puncture) · NACO (National AIDS Control Organisation) · OD (Once Daily) · OI (Opportunistic Infection) · PCP (Pneumocystis jirovecii Pneumonia) · PLHIV (People Living with HIV) · QTc (Corrected QT Interval) · SBAR (Situation, Background, Assessment, Recommendation) · SJS (Stevens-Johnson Syndrome) · TB (Tuberculosis) · TEN (Toxic Epidermal Necrolysis) · TMP (Trimethoprim) · TMP-SMX (Trimethoprim-Sulfamethoxazole) · TPT (Tuberculosis Preventive Treatment) · ULN (Upper Limit of Normal) · WHO (World Health Organization)
References
NACO. National Guidelines for HIV Care and Treatment. MoHFW, GoI; 2021.
WHO. Guidelines on post-exposure prophylaxis for HIV and the use of cotrimoxazole prophylaxis. 2014 (updated 2021).
WHO. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. 2018.
World Health Organization. WHO updated recommendations on HIV clinical management: recommendations for a public health approach. Geneva: WHO; 7 January 2026. [Includes revised and simplified options for TB preventive treatment in people living with HIV. NACO remains the operative source for Indian practice; verify the current NACO edition before changing a TPT regimen.]
Vancouver: Umakanth S. Opportunistic Infection Prophylaxis Pathway [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:
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What is stored
CategoryTherapeutic & Management PathwaysPathway
SpecialtiesInternal Medicine, Infectious Diseases, HIV Medicine
