Backing off Bactrim
by Lark Lands
Reports abound of people on HAART who stop their PCP prophylaxis when their CD4 counts rise. Official guidelines still recommend staying on a preventive regimen (usually Bactrim) if CD4s have ever dropped below 200 (or CD4 percentage below 20)—regardless of where you are now. But two new studies may now give peace of mind to those who went against these recs. In one, 60 HAART responders whose CD4 counts had gone above 200 were followed for more than a year after discontinuing prophylaxis (at an average count of 356); no cases of PCP occurred. In a second study, none of the HAART-induced CD4 rebounders who discontinued prophylaxis (at an average count of 332) developed PCP, after being followed for 13 months. Although long-term studies are necessary to establish the safety of going off PCP prophylactic meds, and the lowest safe discontinuation point, for now the news is good.