218.4 📌 章末速蚘

  • CD4 stratification:
    • < 200: PJP
    • < 100: Toxo, Crypto, MAC, PML, KS
    • < 50: CMV retinitis, severe disseminated MAC
  • PJP: TMP-SMX 15-20 mg/kg/d × 21d + steroid if A-a > 35 / PaO2 < 70
  • Toxoplasmosis: sulfadiazine + pyrimethamine + leucovorin × 6 wk (or TMP-SMX); MRI multi-ring enhancing
  • Cryptococcal meningitis: AmB lipo + flucytosine × 14d → fluconazole 800 × 8 wk → 200 maintenance; repeated LPs; delay ART 4-6 wk
  • MAC: clari + ethambutol + rifabutin ≥ 12 mo; CD4 < 50
  • CMV retinitis: valganciclovir 900 bid × 21d induction; CD4 < 50
  • PML: JC virus, MRI multifocal demyelination no enhancement; ART = primary
  • PCNSL: EBV-driven, single enhancing, methotrexate + ART
  • Prophylaxis: TMP-SMX (PJP + Toxo) when CD4 < 100-200
  • Discontinue: CD4 thresholds restored on ART
  • Delay ART for cryptococcal meningitis only (4-6 wk per COAT)
  • 盧醫垫 hint: 新 HIV+ CD4 < 200 → 立即 ART + OI prophylaxis + vaccines