Yes, it can. As with the treatment of PCP, TMP-SMX (Bactrim, Septra) is the most powerful drug to prevent PCP from occurring in the first place. Preventing an infection such as this is known as "prophylaxis." Initially, one double-strength tablet of TMP-SMX every day in patients with less than 200 T-cells was the recommended dose. Today, many health-care providers recommend one single strength tablet once daily or one double-strength tablet be taken three times a week instead. It's just as effective.
As discussed above, many patients have a hard time handling TMP-SMX due to allergic reactions. There are two options: to switch to an alternative prophylaxis (discussed below) or undergo a process called desensitization. In TMP-SMX desensitization, the goal is to teach your body to get used to the drugs. To do this, your doctor can start you on tiny doses of the drug, using the pediatric liquid formula, and increase it gradually over a few days or over a few weeks. This has been shown to be very successful.
If an alternate PCP prophylaxis is necessary, three options are: aerosolized pentamidine (NebuPent), dapsone, and atovaquone (Mepron) . Aerosolized pentamidine is administered using a machine called a nebulizer. This turns the pentamidine liquid into a fine mist that is inhaled. Aerosolized pentamidine must be administered once a month. Dapsone is a tablet, usually taken once a day, sometimes in combination with other antibiotics. Mepron is a creamy liquid that must be taken every day. It should be taken with fatty food in order to be absorbed properly into the bloodstream. Unfortunately, none of these three antibiotics are as effective as TMP-SMX for the prevention of PCP, but do offer a significant benefit.
For HIV+ people who once saw their CD4 cell count fall below 200, only to see it increase above this level due to antiretroviral therapy, stopping PCP prophylaxis is an option. In general, patients should work closely with their doctors to make sure that their CD4 cell counts are, in fact, above 200 and do not show any sign of decreasing below this level again in the immediate future. If the CD4 cell count falls below 200 again, PCP prophylaxis must be restarted.
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