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Thrush - TMP/SMX
Aug 25, 2006

You stated a few weeks ago that, with my hep C regimen kicking me <200, you would recommend PJP prophylaxis. Well, Dr. just prescribed such, but I'm not sure why. I was having lots of maladies about a month and a half ago, including cough, but they're mostly cleared now (nothing bad on chest xray). The thrush is back, though, after a 3 dose regiment of fluconazole; went back on it daily to no improvement or worsening. And then it's TMP/SMX out of the blue; but after reading up on it, it seems a bit too nasty to entice me to use it for prophylaxis only. Having some horrible (or even fatal) reaction "just in case" of PJP is not a chance I'm too keen on; though I know PJP ain't a party either. There was no mention of the thrush per se; does TMP/SMX have any effect on that? I was also on topical ketaconazole for rashes and had a bit of a reaction to that once; so in researching I thought perhaps itraconazole might be a good thing to switch to to get the thrush gone again. In the absence of coughs etc., is it really worth subjecting yourself to TMP/SMX prophy? I'll be done with the hep C regimen in four months, and hope to go >200 then.

Response from Dr. Henry

If you are HIV+ with a CD4 count < 200 then TMP-SMX is used to prevent Pneumocystis pneumonia--for most patients it is well tolerated though HIV+ persons have a higher rate of side effects than the general population. I would not characterize TMP-SMX as toxic-most patients tolerate it well. Use of antibiotics can cause flares of yeast infections in some patients. That is a generally modest problem in a small subset of persons taking relatively low doses of TMP-SMX for prophylaxis. KH

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