Aug 8, 2017
Hello and Thank you in advance. I have been on the generic for bactrim for the last 4.5 years due to diagnosis with PCP and extremely low DC$ count. After switching to Triumeq my CD4 is finally over 200 and I know this is typically the point the prophylaxes can be stopped. My question is, is there a risk to stopping the bactrim assuming everything keeps progressing? I am sort of conflicted since the bactrim gives me a degree of security and given it is cheap and by now my system is pretty accustomed to it would it hurt to just keep taking it, even if it is purely for psychological impact?
Response from Dr. Young
Hello and thanks for posting.
Congratulations on finally crossing the 200 threshold. Patience is a virtue when it comes to CD4 cell recovery from low counts.
Stopping Bactrim prophylaxis is entirely safe in your circumstance, even with a previous diagnosis of Pneumocystis pneumonia (in your situation, this is called secondary prophylaxis), provided that the count has been confirmed (these numbers do fluctuate a lot), and preferably maintained for 3 or more months.
Our CDC HOPS group actually studied (and published) a research study of nearly 500 PLWH way back in 2000 and concluded (as have others) that stopping is safe when you're on ART and have a CD4 >200.
Current US Department of Health and Human Services Guidelines on Opportunistic Infections similarly recommend, "secondary prophylaxis should be discontinued in adult and adolescent patients whose CD4 counts have increased from <200 to >200 cells for >3 months as a result of ART".
I hope that's helpful, and be well, BY
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