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Prophylaxis Regime
Dec 28, 1999

My CD4's and VL started at 40 and 105K respectively. After 6 weeks on Crixivan and Combivir, CD4=102, VL<2.6. So good news there. My doctor has me on Septra DS (daily)to prevent PCP and Zithromax (1200mg/weekly) to prevent MAC. Thus far, I am tolerating all meds with no side effects other than starvation due to food requirements of the Crixivan. I tested negative for TB, hepatitis, and everything else except a positive antibody test for Epstein's which could be problematic down the road requiring daily IV antibotics (could you spread some light on this). The peepers checked out fine and the dental work is in great shape. Other than a bought of Shingles (the time of discovery) which was treated successfully with Acyclovir, I have been 100% healthy.

I made it through last cold and flu season unscathed, maintained an active lifestyle, and added 15 pounds of bulk with a lifting program before starting HIV treatment. I want to make sure I'm doing everything I can to stay as healthy as possible. Is my prophylaxis regime currently strong enough? Should I pursue any other preventative treatments with my doctor? What about pneomia and flu shots, good idea? Or must have? What about stopping prophylaxis if my CD4 climb above 200? My doctor says the literature says this a bad idea. Things I've read say it is a toss up leaning towards better save than sorry. My concern is burning through these antibotics. In some cases the alternative treatments do not look too pleasant (i.e., IV antibotics). Your thoughts?

Finally, I know this the wrong forum, but I appreciate your thoughts on CD4 recovery and what I can do to aid the recovery process, if anything. I'm after my doctor to switch me to a more food friendly treatment regime. He does not want to move away from the winning combination (well tolerated, no side effects, complete viral suppression) until we see how much of a CD4 bounce I'm going to get. Does the treatment regime really matter in terms of CD4 rebound or is it a matter of complete viral suppression which will allow the CD4's to come back?

I know this is a lot of information and I asked a lot of questions, hack and edit at will.... and thank you in advance :-)

Response from Dr. Feinberg

Your current OI prophylaxis regimen is fine. Once you've been over 100 T cells for at least 3-6 months you can safely stiop the azithromycin; once they've been over 200 for at least 3-6 months, you can safely stop the Bactrim. These are the most recent recommendations from the US Public Health Service (MMWR 8/20/99-- you can probably access this through the CDC's website at www.cdc.com, if you want to read chapter & verse).

Indinavir (Crixivan) can be hard to take because of the empty stomach requirements, but your doctor can convert this to a twice a day regimen if 200 mg of ritonavir are added to 800 mg of indinavir, taken approximately every 12 hours (I'd suggest doing this with food to minimize side effects). You can keep the rest of your HIV meds the same.

And you're correct, we think T cells improve because the HIV is suppressed, not because you receive one drug and not another.


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