In an HIV patient with a CD4 count below 100 cells/µL, prophylaxis for cryptococcosis is recommended with which antifungal agent?

In an HIV patient with a CD4 count below 100 cells/µL, prophylaxis for cryptococcosis is recommended with which antifungal agent?

• A. Acyclovir
• B. Fluconazole
• C. Valacyclovir
• D. Itraconazole

Answer: (B)

Cryptococcal prophylaxis requires an agent active against Cryptococcus with good central nervous system penetration. Fluconazole fits this need, reliably inhibiting Cryptococcus and reaching the CNS to help prevent cryptococcal meningitis in patients with very low CD4 counts. The antivirals listed (acyclovir and valacyclovir) target herpesviruses, not Cryptococcus, so they won’t prevent cryptococcal disease. Itraconazole is an antifungal as well, but it’s less consistently effective against Cryptococcus and offers less reliable CNS penetration, making fluconazole the preferred choice for this prophylaxis scenario.

Cryptococcal prophylaxis requires an agent active against Cryptococcus with good central nervous system penetration. Fluconazole fits this need, reliably inhibiting Cryptococcus and reaching the CNS to help prevent cryptococcal meningitis in patients with very low CD4 counts. The antivirals listed (acyclovir and valacyclovir) target herpesviruses, not Cryptococcus, so they won’t prevent cryptococcal disease. Itraconazole is an antifungal as well, but it’s less consistently effective against Cryptococcus and offers less reliable CNS penetration, making fluconazole the preferred choice for this prophylaxis scenario.