PCP Prophylaxis Question
Dec 9, 2009
have a question about starting prophylaxis for OIs. My boyfriend was diagnosed HIV positive at the end of November 2009. We received his lab results back last week, & his CD4 was 75; his viral load was 136,000. His ID doctor started him on Atripla which he has been taking for 5 days now, with only a few side effects. He is also currently trying to get rid of a jock itch infection that he's had for months & he was also diagnosed with oral thrush last week. Right now he's taking Diflucan for the thrush, but that's it. I've read that people with his low CD4 count should be on Bactrim or Dapsone to prevent PCP. His doctor recommended that he get the seasonal flu shot & the swine flu shot, but when he asked her about a pneumonia shot she told him there was no need. After worrying ourselves to death, he finally called her yesterday & left her a message asking if he needed to be on prophylaxis for PCP. He later received a voicemai! l from her stating that she didn't believe he needed prophylaxis because she felt his chances of contracting PCP were very low due to the fact that he had not been having problems with pneumonia or any other respiratory illnesses & because she didn't believe he would contract pneumonia between now & the time when his immune system starts to reconstitute itself. She described it as sort of a "wait & see" thing. She also said that she didn't want to subject him to the side effects the particular medications to prevent PCP have, partly because he is just now getting over a very bad skin rash.
So is the normal protocal? Or should he be on prophylaxis for PCP? I'm very worried about him & I don't want to gamble with his life. She said she would be happy to write a prescription for prophylaxis if he wanted it, even though she didn't think it was necessary. Should we go ahead & take her up on that offer? Does he need to find a new doctor?
Any advice or suggestions would be very much appreciated.
Response from Dr. Young
Prevention for pneumocystic pneumonia is recommended for all persons with CD4 counts less than 200 (or with a clinical diagnosis of AIDS). Bactrim (trimethoprim/sulfa, or it's alternative, dapsone) is inexpensive (generic) and usually very well tolerated. Bactrim is dosed single strength (SS) once-daily or double strength (DS) three times a week.
I'd refer your hubby's doctor to current US, international or World Health Organization treatment guidelines.
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