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]

People 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 people 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 people with HIV who have a positive serological test for coccidioidomycosis; CD4 counts <250 cells/microlitre; and an absence of signs, symptoms, or laboratory abnormalities compatible with coccidioidal disease.[23] Primary prophylaxis can be discontinued when the CD4 count is ≥250 cells/microlitre and when viral suppression is documented.[23] For people with CD4 counts already ≥250 cells/microlitre and with viral suppression on antiretroviral therapy (ART), primary prophylaxis with antifungal therapy is not indicated and only close clinical follow-up is recommended.[23]

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