IDSA Recommendations for Preventing and Managing Microsporidiosis in HIV-AIDS

Preventing Chronic Microsporidiosis:

 • Because chronic microsporidiosis occurs primarily in persons with advanced immunodeficiency, initiation of ART before the patient becomes severely immunosuppressed should prevent the disease 

Managing Microsporidiosis:

 • Initiate or optimize ART with immune restoration to CD4 count >100 cells/mm3

 • Severe dehydration, malnutrition, and wasting should be managed by fluid support and nutritional supplements

 • Anti-motility agents can be used for diarrhea control, if required

For Gastrointestinal Infections Caused by Enterocytozoon bieneusi:

 • The best treatment option is ART and fluid support

 • No specific therapeutic agent is available for this infection.

 • Fumagillin 60 mg PO daily and TNP-470 are two agents that have some effectiveness, but neither agent is available in the United States.

 • Nitazoxanide may have some effect, but the efficacy is minimal in patients with low CD4 cell count, and cannot be recommended 



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