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Prophylaxis Fatigue and Confusion
Aug 4, 2010

Hi Dr. I have a question concerning the use of prophylaxis. I've been HIV+ for 9 years and off meds with cd4 of 24 at 4%. I have finally committed to treatment again after my last course of 2+ years of truvada*boosted Reyataz never achieved full viral suppression, and side affects. So in reality, for the last 4+ years I've been WELL below 100 CD4's yet I've never had an infection. I have no resistance to any approved drug. Now I am starting Truvada+boosted Prezista+Isentress to try and stamp it out fully and hopefully have a quick cd4 recovery. I'm rambling. I also take fluconazole, valtrex (shingles prevention), azithromycin, and Mepron(which I honestly don't take). I'm tired of SO many pills every day. I've read on this site as well as another HIV related website that prophylaxis for thrush, shingles, and to some extent MAC is not recommended due to drug resistance strains. This would cut out my fluconazole, valtrex, and azithromax. The latter I don't have a problem with. In your opinion, with no history of prior related infections for which these treat, could I safely stop? Drug interactions and the possibility of resistance strains against the prohylactic drugs concern me, especially since I'm 37 years young and may need them later in life. Your thoughts? FYI, just 3 weeks in on ARV so I won't know my current cd4 until Sept., so I assume they are around 50 possibly??? Thanks.

Response from Dr. Henry

The risk for opportunistic infections may be lower than the CD4 count might suggest for persons on effective HIV meds so the first priority should be to achieve full suppression of HIV levels. PCP is often the highest priority but you are sulfa allergic (assumed by your use of Mepron) so that is your decision regarding taking the Mepron for a while until CD4 count > 200 (can also consider aerosolized pentamidine). Your concern about polypharmacy is legitimate but resistance from the meds has not been much of a problem fortunately. Hopefully you will suppress rapidly (usally the case with that regimen)and have a reasonable CD4 recovery so that the prophylactic meds can be stopped. KH



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