Question
How soon can I stop pentamidine prophylaxis?
9 June 2011. Related: All topics, Opportunistic infections, Starting treatment, Stopping treatment.
I have a CD4 count of 168 after 3 months on treatment and my viral load is undetectable. My base level CD4 was 90.
I am receiving pentamadine to prevent PCP as I had a severe allergic rash to Septrin. How long do I need to have the pentamidine? Can I stop as soon as I reach 200? Or do I need to continue till at least I have two results showing a CD4 of 200?
Also, is there any longterm damage to my body caused by the pentamadine?
Tks vm for your help.
Answer
Hi
Thanks for your question.
Most studies looking at stopping prophylaxis for PCP, whether with Septrin or pentamidine, have looked at people after their CD4 count has risen to over 200. However, in practice, after a significant CD4 count increase in someone who is one HIV treatment, many doctors are confident that the risks of discontinuing prophylaxis are very low, especially if the CD4 count is already approaching 200.
In this case, in someone on treatment with an undetectable viral load and an increasing CD4 count, so long as you haven’t previously had PCP, it is probably fine to stop before getting to 200.
This study, including people using pentamidine, did not report new cases of PCP over 9 months in people stopping at an average CD4 count of 120 (range 34-184). As the study only had 19 people only limited information can be drawn, but it si useful if you want to show this to your doctor.
PCP prophylaxis is not required with a CD4+ T-cell count below 200 when viral replication is suppressed. (from AIDS 2007).
If you are currently having side effects from the pentamidine, Â then it may even be safer to stop a little early, than to continue until your CD4 count is over 200. This is dependent you never having previously had PCP or other problems with your lungs, and your risk of infection is low, and should only be considered after discussions with your doctor.
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