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Discontinuing prophylactic for PCP
Jun 25, 2001

I was diagnosed pos in 11/00 after a bout with PCP. When discharged from the hospital I was prescribed 1 Bactrim daily, but it did not work apparently and I was back in the hospital within 2 weeks. Upon discharge I was prescribed dapsone. I have felt fine since, Vl is undetectable and TC4 is about 250. The dapsone scrip ends next week (no refill). I know 200 is not an absolute cutoff for PCP- what would be early signs with which I could avoid another hospitalization, please? Thank you.

Response from Dr. Feinberg

A number of studies have shown that if your viral load is undetectable and your CD4 (T4) cell count is above 200 for at least 3-6 months, that you can then safely stop PCP prophylaxis. It sounds like you may meet these criteria, although I can't tell for certain from your message.

You are correct in saying that bouts of PCP can happen at CD4 cell counts above 200, although your undetectable viral load should provide reasonable protection. The symtpoms of PCP can be very gradual in onset. Typically, there is fever, a dry cough, fatigue, chest discomfort or tightness, thrush, and finally shortness of breath with activity. Not everyone has all of these "classical" symptoms. If you decide to stop the dapsone, contact your physician if you have a prolonged respiratory illness. Good luck!

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