I have a good friend whose t-cells went from 290 and non-detectable viral load to 188 and a viral load of 4000. He is allergic to Bactrim, Dapsone, and Mepron. Is there anything else he can take? He feels fine other than some stress at work.

Thanks for your post.

The first question I have is why your friend's viral load has increased and CD4 decreased- has he gone off of therapy? Is there some issue with drug resistance?

WIth a CD4 count of 188, he is minimally at risk for PCP. I'd be more interested first, in getting him back on successful HIV treatment. This should very quickly get his CD4 count above 200 and dramatically reduce his risk of Pneumocystic pneumonia.

Should this not be feasible, there are a couple of strategies to deal with the PCP preventive treatment. First would be an attempt to desensitize him to Bactrim- this involves using miniscule and gradually increasing doses of Bactrim to eliminate the allergic reaction. This strategy is preferred for long-term PCP prevention and is successful in a large number of individuals. Failing this, there are several alternative PCP preventive medications such as primiquine/clindamycin or chloroquin/clindamycin or pentamidine.

Hope this helps. BY