Q and A


Why am I on ilvitrim? (co-trimoxazole)

I am worried why my CD4 count is dropping so fast,what can i do to keep it above 500? I am currently put on ilvitrim, why ilvitrim?



Thank you for your email. Can you give me a bit more information?

It would be useful if you could tell me what your most recent CD4 count is, and the last few results so that I can understand how quickly this is decreasing.

If your CD4 count is above 500, then your immune system is still very strong. This is likely to slowly go down over time until you start ARVs. This is the only proven way to increase your CD4 count.

The CD4 count guideline for starting treatment will depend on where you live. Can you tell me which country you live in? For example, in the UK, the current recommendation is to start when the CD4 count is about 350.

Ilvitrim is a brand name for two antibiotics in one pill. The generic name for this is co-trimoxazole. Other common brand names are Purbac, Septrin and Bactrim.

The two drugs in co-trimoxazole are trimethoprim (TMP) and sulphamethoxazole (SMX). It is mainly used to either prevent or treat infections, including PCP which is a type of pneumonia and toxoplasmosis which can affect your brian.

In the UK, this med is given to everybody who has a CD4 count under 200. In some other countries, especially in Africa, this is used at higher CD4 counts (under 350) because it also protects against a broad range of other infections.

As with any medicine, it is important to ask your doctor or nurse these questions so you understand this part of your life.


  1. Josh Peasegood

    Hi Monica, yes it is safe to continue breastfeeding. NVP is given by the guidance of WHO guidelines. As you are still taking your medication, there is no need for baby to remain on NVP anymore. After the initial first few weeks/months of taking NVP (taken as determined appropriate by your doctor) there is no additional benefit to continue with NVP. Baby is safe.

  2. Monica

    Hi I am Monica,n my son is 2 months n 2 weeks n they gave him NVP for the 1st six months n now they didn’t give him anything…so I was asking if he is safe or not as I am breast feeding n drinkingy medication

  3. Josh Peasegood

    Hi BFORCE, congratulations on your new baby. It is not recommend to mix feed your baby as this increases risk of HIV transmission. WHO guidelines suggest solely breastfeeding. Are you able to express for when you are not at home? Or if this is not suitable are you okay to give formula all the time?


    Good day

    I have a 7 weeks old baby boy who tested negative. I got back at work and during the day he is on formula and breastfeed him at night. is it safe to do so?

  5. Roy Trevelion

    Hi Lala,

    It’s good to hear that your immune system keeps your CD4 count above 1000. HIV positive people whose immune systems keep viral load to undetectable and have high CD4 counts are called elite controllers.

    However, even with this good immune response, HIV treatment is still generally recommended in the long-term.

    Please talk to your doctor about your symptoms. You can ask for a diagnosis to find out what’s causing them.

    If you’re thinking about starting HIV treatment, please see this Introduction to ART.

  6. Lala

    Hi I’ve been HIV+ for 13 years and not on treatment due to that my CD4 is always above 1000 but now and then have headache and sometimes chest pain does this mean I have to take ARV this pains happens once in a while then they go away after sometime come back pls help

  7. Lisa Thorley

    Hi Given,

    You’re taking a combination of ARVs (this is the Atrozia) and antibiotics. These medications don’t make a persons bladder weak, neither do they affect your sperm. If you’re having issues you’ll need to discuss this with your doctor.

  8. Given

    Hi i need help,i am 36 years old and i m hiv positive,since I started using this pills Durobac and ilvitrim, bladder is always weak and that makes my body weak i don’t know if i m using right medicine. I need help please.the pills that i m using since i m hiv positive 3 month back is Atroiza, Durobac, Winthrop isoniazid, and now ilvitrim please help because now when i m having sex i don’t produce sperms is just urine.

  9. Lisa Thorley

    Hi Gugu,

    Being positive has no impact on a woman’s chance of getting pregnant. If you are having issues with conceiving you’ll need to discuss this with a fertility specialist.
    You’ve said that your viral load is high, does this meant that you aren’t on medication? If you aren’t on medication then if you want to have children you’ll need to be on meds. Meds are also important for your health.

    If you are on medication and your viral load is still high, this may be a sign that the meds that you’re taking aren’t working like they should do. This will need to be discussed with your doctor.

  10. Gugu

    Hi I’m HIV Can I convince if my viral load is to high. I’m trying to convince for 5yrs after my last born who is 11yrs.


Your email address will not be published. Required fields are marked *