Serologic Testing for Toxoplasma gondii
ÎÎAll HIV-infected patients upon initiation of care should be tested for
prior exposure to T. gondii by measuring anti-Toxoplasma IgG (B-III).
ÎÎToxoplasma-seronegative adults, representing 70-90% of the U.S.
population, should be counseled on how to avoid new infection (B-III).
ÎÎSerologic testing should be repeated for previously seronegative
patients if the CD4 cell count decreases to < 100/mm3, especially if
they are unable to take TMP/SMX (C-III).
Viral Hepatitis Screening and Vaccination Recommendations
ÎÎHIV-infected patients should be screened for evidence of HBV
infection upon initiation of care by determination of HBsAg, HBsAb,
and HBcAb (A-III), and those who are susceptible to infection should
be vaccinated against HBV (B-II). Sexual partners of persons who are
positive for HBsAg should also be offered vaccination.
ÎÎPatients who are negative for HBsAg and HBsAb but positive for
HBcAb should be screened for chronic HBV infection by determination
of HBV load (HBV DNA PCR) (C-III)
ÎÎHIV-infected patients should be screened for HCV infection upon
initiation of care with a test for HCV antibody (B-III).
ÎÎPositive HCV antibody test results should be confirmed by
measurement of HCV RNA by PCR (A-II).
ÎÎInfants born to HCV positive women should be tested for HCV
transmission (A-II).
ÎÎHepatitis A vaccination is recommended for all susceptible men
who have sex with men (MSM), as well as others with indications for
hepatitis A virus vaccine (eg, injection drug users, persons with chronic
liver disease or who are infected with hepatitis B and/or C) (A-II).
ÎÎHepatitis A vaccine may be considered for all other patients without
prior exposure (negative anti-HAV test) (C-III).
Screening and Vaccination Recommendations for Herpesviruses
ÎÎPatients at lower risk of CMV infection (eg, populations other than
MSM or injection drug users, both of which may be assumed to be
CMV-seropositive) should be tested for latent CMV infection upon
initiation of care with an anti-CMV IgG (B-III).
ÎÎPatients who do not have evidence of immunity to varicella should
receive post-exposure prophylaxis with varicella zoster immune
globulin (VariZIG) as soon as possible (but within 96 hours) after
exposure to a person with varicella or shingles (A-III).
ÎÎVaricella primary vaccination may be considered in HIV-infected VZV
seronegative persons greater than 8 years old with CD4 counts
> 200 cells/mm3 (C-III) and in HIV-infected children aged 1 to 8 years
with CD4 levels ≥ 15% (B-II).
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