Ok, I had CNS Non-Hodgkin's Lymphoma, Stage IV, cd4 down to 87, that was nearly 3 yrs ago, then chemo, etc., now my cd4 is 350, HIV ud, I never ever miss my atripla and isentress, not once. My dr says I should take Batrim 3X a week, even now, when I've never had an OI, even when I was dyin' of the blood cancer. I'm worried about the long term effects of bone marrow suppression bactrim causes (I was on it every day for 2 and a half yrs, until I was put on the 3x a wk regime) Doesn't it kill the "good" bacteria too? I just want to get off of it. Am I a fool?

Hello and thanks for your post.

Bactrim (TMP-SMX)is very strongly recommended to prevent pneumocystis pneumonia in all persons with AIDS or CD4 counts below 200. The medication is generally very safe, only rarely associated with significant bone marrow suppression or problems with bacterial flora.

You've not mentioned how long your CD4 count has been above 350, but substantial clinical studies results support stopping Bactrim prophylaxis once CD4 counts are above 200 for more than 3-6 months. You're not a fool to want to decrease your pill burden or number of medications; it's just reasonable to know the risks and benefits and the best clinical science.

In your case, I'd suspect that it's fine to discontinue if your CD4 count has been above 200 for some time.

Be well, BY