OI Prophylaxis & Prevention Pathway Cotrimoxazole, IPT, Fluconazole & CrAg Screening · NACO 2021 · v1.0
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1. Current Disease Status
2. Prior OI History
⚙ OI Prophylaxis Quick Reference
ProphylaxisStart WhenDrug & DoseStop When
CotrimoxazoleCD4 < 200 or WHO Stage 3/4TMP-SMX 960mg (DS) ODCD4 > 200 for ≥ 6 months on ART
IPT (Isoniazid)All PLHIV after excluding active TBINH 300mg + Pyridoxine 25mg OD x 6 monthsAfter completing 6-month course
FluconazoleAfter treated Cryptococcal disease200mg OD (secondary prophylaxis)CD4 > 200 for ≥ 6 months on ART
CrAg ScreeningCD4 < 100 (before ART)Serum CrAg lateral flow assayIf CrAg+: LP to exclude meningitis; pre-emptive Fluconazole
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: OI (Opportunistic Infection) · CPT (Cotrimoxazole Preventive Therapy) · IPT (Isoniazid Preventive Therapy) · TPT (TB Preventive Treatment) · TMP-SMX (Trimethoprim-Sulfamethoxazole) · INH (Isoniazid) · CrAg (Cryptococcal Antigen) · LP (Lumbar Puncture) · DS (Double Strength) · ATT (Anti-Tubercular Treatment) · ULN (Upper Limit of Normal)
References
  1. NACO. National Guidelines for HIV Care and Treatment. MoHFW, GoI; 2021.
  2. WHO. Guidelines on post-exposure prophylaxis for HIV and the use of cotrimoxazole prophylaxis. 2014 (updated 2021).
  3. WHO. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. 2018.
How to Cite

AMA: Umakanth S. OI Prophylaxis Pathway. MEDiscuss. 2026. Accessed .

Vancouver: Umakanth S. OI Prophylaxis Pathway [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:

⚠ Disclaimer: This decision-support system is intended for healthcare professionals. It does not substitute clinical judgment. These algorithms are evidence-based, but medical knowledge evolves continuously. The treating physician retains absolute responsibility for all diagnostic, dosing, and therapeutic decisions. Always verify outputs against current institutional protocols and individual patient contexts.
© 2026 MEDiscuss.org. All rights reserved. This CDSS Module was designed and developed by
Dr. Shashikiran Umakanth using the available evidence base. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Therapeutic Pathways & Algorithms
Specialties Internal Medicine, Infectious Diseases, HIV Medicine
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