Dear Doctor,

I tested HIV-positive in 2011, and my CD4 count then was 473 cells/ml. Recently when I went for a check-up, it had risen to 737 cells/ml. However, I was not taking drugs. Now my doctor has advised me to start using septrin. Do you think by taking septrin, my CD4 count will continue rising instead of falling? 

Princess

Dear Princess,

It is good  that CD4  count has started to rise without drugs. This indicates that the body’s immune system though impaired to some extent is still working. It is the body’s immune system that has prevented the virus from multiplying and attaching to more lymphocytes.

Septrin is a broad spectrum antibiotic that contains a combination of trimethoprim and sulphmethxazole. It is effective against a wide variety of bacterial, fungal and protozoal  infections including diarrhoea diseases, fatal pneumonias like PCP (pneumocystis  jeroveci  pneumonia), toxoplasmosis that affects the brain, etc

Septrin is used for immune depressed patients to prevent these opportunistic infections, i.e. infections which occur when the body’s immunity goes down. By preventing these infections, it improves quality of life of an affected person and also prolongs it. Moreover it is very cheap and well tolerated.

It is for these benefits of Septrin, that the world health organization has recommended it to be used for all HIV affected individuals for life. It is more useful in resource poor settings, where even patients lack resources for many tests and treatment. The common adverse effects are anemia and allergic skin reactions. Even if one develops mild side effects, it is discontinued for a short time and then restarted after desensitization. In this process, after a gap of a week or so, the drug is started in a lowest dose possible for about 3 days . When the person tolerates it, gradually the dose is increased in miniscule amounts for every 3 days till an optimum dose is reached. If anaemia  develops it can be treated with supplements of folic acid. The drug is discontinued only if life threatening adverse effects develop in some person.