Prophylaxis with Low CD4

Today, Dr. Ditangco discontinued both my prophylaxis because my CD4 is now 487. I’ve been taking cotrimoxazole (bactrim) 800 mg, daily and azithromycin (zithromax), 1250 mg once a week for 8 months now. From what I researched before, if one has low CD4 like below 200 (or 250), the HIV specialist would recommend prophylaxis treatment as prevention of the major opportunistic infections.

I am so happy that at last I can stop taking them. They cost me P3,000 a month.

For the benefit of my readers, I researched on the different conditions and the specific prophylaxis prescribed.

Conditions

PCP

Bactrim (TMP-SMZ)

Dapsone; Dapsone + Daraprim (pyrimethamine) + Leucovorin; NebuPent (aerosolized pentamidine); Mepron (atovaquone)

Use if CD4 count is <200 or CD4% is <14% or if patient has a history of oral thrush.

Discontinue when CD4 count is >200 for 3-6 months.

Risk of recurrence is low if CD4 count increases to above 200 (or CD4% increases to above 14%), but there is currently no recommendation to discontinue secondary prophylaxis.

MAC Infection

Biaxin (clarithromycin); Zithromax (azithromycin)

Mycobutin (rifabutin)

Use if CD4 count is <50.

Discontinue when CD4 count is >100 for 3-6 months with sustained HIV suppression.

Risk of recurrence is low if CD4 count increases to above 100, but there is currently no recommendation to discontinue secondary prophylaxis.

CMV Infection

Cytovene (oral ganciclovir)

Not applicable

May be used if CD4 count is <50.

Discontinue when CD4 count is >150 for 3-6 months with sustained HIV suppression, only if non-sight- threatening lesions are present and the patient can undergo regular ophthalmic exams.

Toxoplasmic Encephilitis

Bactrim

Dapsone + Daraprim; Mepron +/- Daraprim

Start prophylaxis when CD4 count is <100.

Discontinue when CD4 count is >100 for 3-6 months.

After an incidence of toxoplasmic encephalitis, lifelong secondary prophylaxis with Bactrim should be administered.

There is no data to support discontinuing secondary prophylaxis.

Cryptococcosis

Diflucan (fluconazole); Sporanox (itraconazole)

Not applicable

May be used if CD4 count is <50.

After an incidence of cryptococcosis, lifelong secondary prophylaxis with Diflucan should be administered.

Risk of recurrence is low if CD4 count increases to above 100, but there is currently no recommendation to discontinue secondary prophylaxis.

Histoplasmosis

Sporanox

Not applicable

Use if CD4 cell count is <100 and patient lives in area with hyperendemic rate of histoplasmosis.

After an incidence of histoplasmosis, lifelong secondary prophylaxis with Sporanox should be administered.

Risk of recurrence may be low if CD4 count increases to above 100, but there is inadequate data to support discontinuing secondary prophylaxis.

Tuberculosis

Nydrazid (isoniazid); Rifadin (rifampin) or Mycobutin + Pyrazinamide

Not applicable

An individual who has a positive TB skin test but no evidence of active TB should initiate prophylaxis lasting 9 months (Nydrazid) or 2 months (Rifadin/ Pyrazinamide).

Lifelong secondary prophylaxis is not necessary once an individual completes treatment for active TB.

Bacterial Respiratory Infections

Bactrim

Biaxin, Zithromax

Do not use solely to prevent respiratory infections as resistant organisms may develop.

Bactrim may be prescribed for individuals with frequent respiratory infections.



Credits: 
http://www.thebody.com/content/art14578.html