21.6.1 Criteria for starting cotrimoxazole prophylaxis by adult PLHIV
All HIV-positive people at WHO clinical stages 2, 3, 4, or with a CD4 count less than 350 cells/mm³, should start cotrimoxazole prophylaxis. Patients should first be asked if they are allergic to sulfa-containing drugs like Fansidar — if they are, these patients should not be given cotrimoxazole.
Sulfa drugs are mainly antibiotics related to sulphonamide. Many PLHIV may develop adverse reactions to this class of drugs. Cotrimaxazole is a sulfa-containing drug.
The drug regimen for cotrimoxazole prophylaxis is two 480 mg tablets, or one 960 mg tablet daily. Note that you are not expected to either prescribe or refill prophylactic drugs. However, information about the criteria for cotrimoxazole prophylaxis will enable you to identify patients who need prophylaxis, and to refer them to the appropriate health centre.