Question
I started TLD with a CD4 of 27. When can I stop other meds?
2 September 2024. Related: All topics, Southern Africa, Starting treatment, Support, TB.
I started TLD in South Africa in Jan 2024 with a CD4 count of 27. I had haemoglobin levels of 5.7 and I was also put on isoniazid (for TB prevention), Durobac antibiotics and iron supplements. I tested negative for TB, pneumonia and hepatitis.
By April 2024 my viral load was 158.
My anemia is not getting better and I’ve been doing research about Durobac and Isoniazid
Durobac is not recommended for patients with anaemia and isoniazid has anaemia as a side effect
When do I stop these medicines? The nurses at the clinic all give me a different answers, one even said I’ll have to take the medicines for years.
Answer
Hi there
Thanks for your questions and for sharing your experience.
You are really lucky to have been diagnosed before your CD4 count fell even lower. And also that you have had such a strong response to HIV treatment.
Although you say that your viral load was 158 by April, please can I check whether this might have been your CD4 count rather than viral load. Also, do you know your viral load before you started treatment?
If it was your CD4 count this is a good result because it already reduces the risk of many other problems. If it is viral load, then the next result is likely to be undetectable, which is also very good.
Your clinic is giving you very good care. Your very low CD4 count meant that both the antibiotics and the TB prevention meds were very important. The benefit from these meds is likely to be much more important that the smaller risk from anaemia.
Please talk to your doctor about the anaemia though because I am not sure which units the 5.7 result is, so I don’t know how serious this is, Your doctor should tell you how long the Durobac and isoniazid need to be taken for. Also, this might already have improved from taking iron and because of the HIV meds.
This is because both these meds can be used for different times depends on where you live and the level of risk of TB and other infections.
For example, in some countries Durban can be stopped after your CD4 count increases above 200, in others above 350 and in some it is taken until your CD4 count gets above 500.
The doctor has to decide if and when the benefits are still needed or when it is okay to stop because of the concern over anaemia.
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