Prophylaxis in HIV and “Crack Lung”

Prophylaxis in HIV and first line treatment

  • CD4 < 200
    • PCP: TMP/SMX DS 1 Tab daily
  • CD4 < 100…above plus…
    • Toxo (if seropositive): TMP/SMX DS 1 Tab Daily
    • Histo (if living in endemic area): Itraconazole 200mg Daiily
  • CD4 < 50…above plus…
    • MAC: Azithromycin 1200mg weekly

“Crack Lung”

  • A syndrome of diffuse alveolar damage and hemorrhagic alveolitis that occurs within 48 hours of smoking crack cocaine.
  • Can be associated with diffuse alveolar hemorrhage or eosinophilia on bronchoscopy
  • Treatment is supportive with O2, bronchodilator therapy, and ventilation when indicated. Usually patients receive abx while being worked up for concomitant infections

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