Which is the recommended prophylaxis for patients with a CD4 count less than 50 cells/mm³?

When considering prophylaxis for patients with a CD4 count of less than 50 cells/mm³, the recommended choice focuses on preventing specific opportunistic infections that can occur at this level of immunosuppression. In patients with such low CD4 counts, there is a significant risk for developing infections including Mycobacterium avium complex (MAC), which is an important concern among those with advanced HIV disease.

Azithromycin is recommended as prophylaxis against MAC infection for patients with a CD4 count below 50 cells/mm³. The use of azithromycin helps reduce the risk of this serious infection, which can lead to systemic illness characterized by fever, weight loss, and debilitating diarrhea.

In contrast, Trimethoprim-sulfamethoxazole is primarily used for prophylaxis against Pneumocystis jirovecii pneumonia (PCP) and is typically indicated when CD4 counts drop below 200 cells/mm³. Fluconazole is used for prophylaxis against candidiasis and is indicated in specific settings, while the pneumococcal vaccine is advised for vaccination but does not serve as prophylaxis for opportunistic infections in the same sense.

Thus, the correct choice highlights the importance of targeting specific pathogens based on the degree