Management and prophylaxis

There  is  a  poor  prognosis  with  a  high  mortality  rate  in  the setting of delayed diagnosis and antifungal therapy. Standard primary treatment is 2 weeks of parenteral amphotericin B at a dose of 0.6 mg/kg/day, followed by 400 mg of itraconazole per day orally in two divided doses for 10 weeks.[101] Prolonged secondary suppressive therapy with oral itraconazole (200 mg once daily) is required to prevent relapse.[102]

All patients with HIV infection and with CD4 counts below 100 cells/ μL who reside or stay for a long period in South East Asia, particularly in rural areas, should be administered primary prophylaxis. Oral itraconazole, 200 mg/day is the preferred choice, but an alternative drug is oral fluconazole 400 mg once weekly. Primary prophylaxis is not formally indicated in other geographic areas to date.[103]