Question

A 56-year-old man presents for a routine follow-up regarding his positive HIV status. He is compliant with his medications and has been feeling well. In addition to his antivirals, he takes daily trimethoprim/sulfamethoxazole for Pneumocystis jiroveci pneumonia (PCP) prophylaxis.

What detail of his history would warrant the prophylaxis?

1. CD4 cell count <400
2. History of previous PCP infection
3. CD4 cell count >200
4. History of any previous pneumonia infection
5. HIV viral load >100,000 copies/mL

Answer 1

Prophylaxis with trimethoprim/sulfamethoxazole in a 56-year-old HIV-positive man is warranted due to his CD4 cell count being below 200, indicating a high risk for opportunistic infections such as Pneumocystis jiroveci pneumonia.

Step-by-step explanation:

The detail of the 56-year-old man's history that warrants the prophylaxis with daily trimethoprim/sulfamethoxazole for Pneumocystis jiroveci pneumonia (PCP) prophylaxis is his CD4 cell count being below 200.

Patients with HIV are diagnosed with AIDS when their CD4 T-cell count drops below this threshold, which significantly compromises their immune system, leaving them highly susceptible to opportunistic infections like PCP.

PCP prophylaxis is typically recommended for HIV-positive individuals with a CD4 count <200 to prevent the onset of this potentially fatal pneumonia.