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Survival in persons with AIDS has been markedly increased through prophylaxis for
PCP, primarily through use of trimethoprim-sulfamethoxazole (TMP-SMX), dapsone, or
aerosolized pentamidine. Antipneumocystis medication is recommended for AIDS patients with
CD4 lymphocyte counts <200/µL. Patients who receive antiretroviral therapy and who have a
CD4 count that remains above 200/µL for more than 3 months can safely discontinue PCP
prophylaxis.[308] Pyrimethamine-sulfadoxine has also been used for PCP prophylaxis. Adverse
drug reactions (skin rash, fever, leukopenia, hepatitis) occur in half of patients taking TMP-
SMX, and may necessitate an alternative therapy, but the other agents are also associated with
adverse reactions.[208] Patients with access to routine medical care may have multiple episodes
of PCP diagnosed and treated successfully over months to years. However, patients with AIDS
may still succumb to PCP in their terminal course.[417]
There is evidence that some P jiroveci (carinii) strains are developing resistance to sulfa
drugs. This is mediated via mutations in the dihydropteroate synthase (DHPS) gene. Resistance
is more commonly demonstrated in persons who have been receiving PCP prophylaxis. In the
st
early 21 century, however, drug regimens still remain effective.[400]
