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2–38 | Clinical Manual for Management of the HIV-Infected Adult/2006
pregnancy. Prophylaxis that includes pyrimethamine
generally should be deferred until after pregnancy,
although pyrimethamine may be used with caution to
treat active toxoplasmosis during pregnancy in sulfaallergic
patients.
Patient Education
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Discuss adverse effects of the selected medication(s)
and how the patient should respond in the event of
rashes, diarrhea, and other complications.
Explain the purpose of each medication, and be sure
that patients understand the dosage and frequency
of administration.
Reinforce the need to continue the medication
indefinitely (potentially for life) to reduce the risk of
the OI.
OIs can occur despite prophylaxis. Instruct patients
to call their health care providers if they become ill.
Counsel patients who are Toxoplasma IgG negative
to avoid exposure to Toxoplasma. Specifically, they
should avoid eating raw or undercooked meat,
especially pork, lamb, game, and venison. Patients
should wash hands after handling raw meat and
after gardening or contact with soil. Encourage
patients not to adopt or handle stray cats, and, if they
own cats, to wash hands thoroughly after cleaning
litter boxes. (See chapter Preventing Exposure to
Opportunistic and Other Infections.)
For women of childbearing potential who are taking
clarithromycin, emphasize the need for effective
contraception to avoid potential teratogenic effects
of clarithromycin.
References
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Centers for Disease Control and Prevention,
National Institutes of Health, HIV Medicine
Association/Infectious Diseases Society of America.
Treating Opportunistic Infections Among HIV-Infected
Adults and Adolescents. MMWR Recomm Rep.
2004 Dec 17; 53(RR15);1-112. Available online
at aidsinfo.nih.gov/Guidelines/GuidelineDetail.
aspx?GuidelineID=14. Accessed May 19, 2006.
El-Sadr WM, Murphy RL, Yurik TM, et al.
Atovaquone compared with dapsone for the prevention
of Pneumocystis carinii pneumonia in patients with
HIV infection who cannot tolerate trimethoprim,
sulfonamides, or both. N Engl J Med. 1998 Dec
24;339(26):1889-95.
Hardy WD, Feinberg J, Finkelstein DM, et al. A
controlled trial of trimethoprim-sulfamethoxazole or
aerosolized pentamidine for secondary prophylaxis of
Pneumocystis carinii pneumonia in patients with the
acquired immunodeficiency syndrome. N Engl J Med.
1992 Dec 24;327(26):1842-8.
Masur H. Prevention and treatment of
pneumocystis pneumonia. N Engl J Med. 1992 Dec
24;327(26):1853-60.
Sande MA, Eliopoulos GM, Moellering RC, et al.
The Sanford Guide to HIV/AIDS Therapy, 14th ed.
Hyde Park, VT: Antimicrobial Therapy, Inc.; 2005.
U.S. Public Health Service, Infectious Diseases
Society of America. Guidelines for preventing
opportunistic infections among HIV-infected persons.
MMWR Recomm Rep. 2002 Jun 14;51(RR08);1-
46. Available online at aidsinfo.nih.gov/Guidelines/.
Accessed May 19, 2006.