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Sep 18, 2009

Greetings again from the Philippines!

Hi Doc BY,

Thanks for your reply.

My Viral load is 47 copies as of August 2009 CD4 April 27. 2009- 163 - 10.81% CD4 August 25,2009 - 73 - 5.29%

Is there a significant decrease? My doctor told that its okay not to take prophylaxis but I am really concerned about infections.

My other doctor told me to take Kraricid 500 mg two times a day to protect me from infection since I have allergy to Bactrim.

Please help and hope to hear again from you soon.

Thank you and God Bless!


Response from Dr. Young

Hello again; sorry for the delay in this reply.

If you didn't have any acute illness in late August, then I'd actually call the difference between the two CD4 tests significant. Whenever there's concern about an unexpectedly abnormal lab test, I'll repeat the test to be sure.

In any event, both tests show a CD4 count below 200 (or 15%)-- and indicate strongly the need to be on medications to prevent Pneumocystic pneumonia. As you note, Bactrim (trimethoprim/sulfa) is generally the drug of choice for this task; among persons who are sulfa allergic (as you seem to be), there are a number of alternative medications. Clarithromycin (Kraricid or we call Biaxin here in the US) is not something that prevents PCP, but rather is used to prevent certain mycobacterial infections (like M. avium/MAC). In the US, we'd only prophylax against MAC in persons whose CD4 counts are below 50 cells-- your's are close enough that in the short term, it's ok to use. However, you and your doctor should know that in persons like you who might be sulfa allergic, there are simple strategies to successfully desensitize you to the sulfa and allow you to take Bactrim daily without risk.

Sorry again about the delay. Be well,



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