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  • 1.  Prophylaxis Guidelines with HIV and Cancer management

    Posted 11-27-2022 08:24
    What are the guidelines regarding monitoring a PLWH who is virally suppressed for multiple years but their absolute CD4 dropped below 200 from the lymphocytopenia due the cancer, with the CD4 percentage way above 14.

    Jeremy Aguinaldo
    Macon GA

  • 2.  RE: Prophylaxis Guidelines with HIV and Cancer management

    Posted 02-01-2023 14:04
    Hi there,
    Late reply, but I was just browsing the discussions. I have some patients in this situation. I believe in the Oncology literature, if a patient is going to have prolonged CD4 suppression (due to chemo or their disease itself), irrespective of HIV status, they sometimes prescribe PJP and other fungal ppx. Therefore, I think if it's consistent with their goals of care, you could put the patient on PJP ppx - especially if they can take an easy regimen, like Bactrim - but you could check with the oncologist as well.

    Julia Cooper MD, AAHIVS
    New York, NY

  • 3.  RE: Prophylaxis Guidelines with HIV and Cancer management

    Posted 05-25-2023 21:22
    Edited by Debbie Nguyen 05-25-2023 21:22

    Hi Jeremy,

    The two guidelines in the U.S. for cancer treatment are the NCCN and ASCO guidelines. I found the NCCN oncology guidelines providing guidance depending on the type of cancer. For my HIV patients, newly diagnosed with cancer, I scan the NCCN guidelines, by pulling up that specific cancer and follow the flow chart/algorithm to view recommendations for OI prophylaxis and counsel them on food safety due to CD4 count drop putting them at risk of OI. 

    Below is a PDF link of such an example. I recommend creating an account on the NCCN network to view the latest guidelines as the link available publicly may not be the most recent.

    Debbie Nguyen, PharmD, AAHIVP
    Seattle, WA