Preventive. Adults whose HIV infections have substantially damaged their immune systems, as indicated by CD4+ T -cell counts of 200 or lower should receive medication to prevent PCP. A recent clinical study found that TMP/SMX, dapsone and aerosolized pentamidine were equally effective in delaying a first episode of PCP. However, for patients with fewer that 100 CD4+ T cells, TMP/SMX and dapsone were substantially more effective than aerosolized pentamidine in delaying an initial bout of PCP. Because young children normally have larger numbers of CD4+ T cells circulating in their blood than do adults, the levels of T cells used to determine when to treat children with HIV infection to prevent PCP vary with the age of the child.
Advise the patient to quit smoking, rest, avoid excess alcohol intake, maintain adequate nutrition, and avoid exposure to crowds and others with upper respiratory infections. Teach the patient appropriate preventive measures, such as covering the mouth and nose while coughing when in contact with susceptible individuals. Be sure the patient understands all medications, including the dosage, route, action, and adverse effects. Teach the patient to recognize symptoms, such as dyspnea, chest pain, fatigue, weight loss, fever and chills, and productive cough, that should be reported to healthcare personnel.