Primary prevention

Primary prevention measures are limited for immunocompetent individuals. Travellers should limit exposure to outdoor dust in endemic areas; during dust storms, they should stay inside and close windows. Air filtration measures can be used indoors.[8]

Patients with HIV who live in or visit endemic areas are particularly encouraged to heed the above advice, as well as to avoid long periods of exposure to disturbed native soil (e.g., at building excavation sites).[23] Serological testing for coccidioidomycosis is advised in patients with HIV who have previously travelled to or lived in endemic areas.[23] Annual to bi-annual testing should be considered for those currently living in endemic areas.[23] Primary prophylaxis with fluconazole is indicated for HIV-positive patients with a positive serological test for coccidioidomycosis; CD4 counts <250 cells/mm³; and an absence of signs, symptoms, or laboratory abnormalities compatible with coccidioidal disease.[23] Primary prophylaxis can be discontinued when the patient’s CD4 count is ≥250 cells/mm³ and when viral suppression is documented.[23] For patients with CD4 counts already ≥250/mm³ and with viral suppression on antiretrovirals, primary prophylaxis with antifungal therapy is not indicated and only close clinical follow-up is recommended.[23]

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