In HIV/AIDS patients, starting with WHO Stage 3 (see Chapter 11 for staging criteria)
All adult persons with symptomatic HIV disease including all symptomatic pregnant women after the first trimester and before 37 weeks of pregnancy.
All children born to HIV positive women from six weeks of age and those identified, as being HIV positive within the first year of life until proven HIV negative or intolerant to Co-trimoxazole or have a CD4 count > 15%
Children older than 12 months who have symptomatic HIV disease or CD4 < 15%.
Asymptomatic HIV infected individuals with CD4 counts <200 cells/ml
It should be noted that baseline LFT and RFT are required before long term administration of Co-trimoxazole
Adults - One double strength tablet (160/800 mg) or two single strength tablets once a day on a daily basis. For those with < 60kg, see ARV dosing chart, which includes Co-trimoxazole dosing,
Children - Co-trimoxazole: see paediatric dosing chart.
Prophylaxis is for life for both adults and children who are not on ARVs.
For those on ARV’s, co-trimoxazole prophylaxis can be stopped if CD4 is >200
Children who are born to HIV infected women can stop prophylaxis when HIV infection has been reasonably ruled out and the risk of exposure has ceased.
Children older than 18 months can continue with the prophylaxis only if the diagnosis of HIV infection has been confirmed by serology
Criteria for stopping
Occurrence of severe side effects such as severe cutaneous reactions, or such as fixed drug reactions
If ART is initiated and CD4 count is above 200 cells/ml in adults or above 15% in children
Renal and/or hepatic insufficiency or severe haematological toxicity if anti retroviral agents are used
Regular follow up initially every month for the first three months, then every three months if the medication is well tolerated.
It is mandatory to monitor for side effects and adherence. Monitoring includes assessment of skin reactions, measurements of haemoglobin, and white blood counts every six months and when clinically indicated.