Whilst we should try to adhere to the guidelines re PJP prophylaxis for sustained CD4 counts over 200 prior to cessation, there is enough reason to not panick if a patient is having difficulty being adherent , and

1. Their CD4 count is above 100, or

2. Their CD4 count is above 75 and the viral load is <400

and

3. They do not have underlying lung disease or another cause of immunodeficiency.

This particularly useful to have in mind for those patients with difficulty with adherence and a Bactrim allergy! It might be easier to prioritise another medication as opposed to upset rapport by trying to administer pentamidine or atovaquone which are less efficacious.