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Bactrim's long term effects?

May 3, 2009

I've been on Bactrim for 2 yrs now ... what are the long term effects..... my t cells are below 100, but I'm in wk 30 of my PegInterferon/Ribavirin HepC therapy. Dr. says I can get off of Bactrim when my CD4 gets above 200 ... but doesn't l.t. Bactrim use suppress CD4? Is the Bactrim really any good as a prophylactic for infection??? Thank you!

Response from Dr. McGowan

Bactrim (trimethoprim-sulfamethoxazole) is used to prevent opportunistic infections (infections that take advantage of an immune system that is out of balance), especially Pneumocystis and Toxoplasmosis. Bactrim is highly effective as a preventive medication for these conditions (and probably bacterial pneumonia as well) and is responsible for saving lives (this was especially seen before we had effective treatment for HIV itself). It is true that bactrim has some suppressive effects on the body's ability to make white blood cells, but this is not on the same scale that interferon has. Using a three times a week dose may help lessen that effect. There is no long-term effect of bactrim on the bone marrow and your counts will improve once you are off the HCV treatment. Alternatives such as atovaquone that have less effects on the marrow do exist, but it is expensive and may also effect the liver. Dapsone is possible but may also cause anemia (a special test called a G6PD level must be tested first) and would not be effective against toxoplasmosis (which would require a separate medicine, pyrimethamine, which also causes decrease in white blood cell count!). To make a long story short, as long as you tolerate it, bactrim is a safe and effective treatment when your CD4 is low.

Good luck, Joe

should I do PEP?
Ziagen plus Atripla?

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