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fluconazole and Dapsone duration
Jul 27, 2013

Dear dr. Young I'm 43-years old and i was diagnosed at 1-15-2013. Cryptoccocal meningitis was the first manifestation of my disease. CD4 at dx. was 20 and VL 33.000. i was treated with conventional Amphotericin (failed) and than with Ambisome+Flucytosine. Brain Iris was diagnosed clinically and by MRI. Prednisone was administered for tot. of 3 months with gradual tapering off. m184 and partial resistence to RAL where observed during Truvada and Isentress therapy. know i'm Darunavir, Ritonavir, Truvada and Maraviroc.. my CD$ are 202 (%13> 14.2) and VL 26. I take Fluconazole 400mg once a day and Dapsone 100mg once daily (SMS-TMP allergy). I asked my HIv specialist when i can stopthese prophylactic medications and he said to me: you need Dapson for 6 months while maintaining a CD4 over 200. Fluconazole- i don't know for how long. can you explain this to me please? my HB=11.7 my doc. thing because of the Dapsone. do i must take it every day? 100mg per day or can i take less? i would appreciate a lot your opinion, advise and recommendation! thank you very much!

Response from Dr. Young

Hello and thanks for posting.

Seems like you're making a great recovery from very advanced HIV/AIDS.

Your question is when secondary prophylaxis for cryptococcal meningitis and pneumocystis can be safely discontinued. With regard to the first, the USPHS/IDSA guidelines recommend discontinuation of secondary prophylaxis if patients successfully complete a course of initial therapy for cryptococcosis (some recommend 12 months), remain asymptomatic with respect to signs and symptoms of their cryptococcosis, and have a sustained increase (>6 months) in their CD4 counts to >100-200 cells/L on ART.

PCP prophylaxis can similarly be discontinued if CD4 count increased from <200 cells/L to >200 cells/L for >3 months in response to ART. (Dapsone for prophylaxis is dosed daily.)

Based on this, you've got a little bit longer to go on treatments- probably after the first of the year for the fluconazole, and at least 3 months more for the Dapsone.

For more information about the treatment of opportunistic infections, I'd direct you (or your doctor) to the DHHS opportunistic infection guidelines.

I hope that helps and wish you good health, BY



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