Dear Doctor,

I had a PCP diagnosis four months ago, which was successfully treated with Bactrim .....my question is -- with a T cell count of under 30 and viral load of 40,000....what are the chances of contracting this OI again?....The hospital advised me on continuing with bactrim 3 times per week...but I have been rather reluctant to do this.........I also refuse to go on combination therapy..........I wish to remain healthy, but am worried that this OI will return soon......your comments would be greatly appreciated.....

You are putting your worries in the wrong basket. With less than 30 T cells, you are not only vulnerable to PCP but to all the other unpleasant and potentially fatal complications of AIDS. Wasn't your hospital stay unpleasant enough to cure you of wanting to be sick again? It is of course your choice, but if I were you I'd get combination therapy as fast as I could -- it's your only ticket back to health and a reasonable life expectancy. In the meantime, the hospital is right, continuing to take Bactrim will provide decent protection against PCP (but not against the host of other illnesses that occur at end-stage HIV disease). It would probably be easier to remember if you took it once a day. When your T-cells are greater than 200 for at least 3-6 months, then you can stop taking the Bactrim. Also, with such a low T-cell count you could benefit from azithromycin 1200 mg once a week to prevent Mycobacterium avium complex (MAC) disease. Get going and good luck!