Q: How does WHO staging guide co-trimoxazole prophylaxis?

WHO recommends co-trimoxazole prophylaxis for adults and children with WHO clinical stage 3 or 4, or any stage if CD4 350 cells/μL for ≥6 months on ART.

Question 1

Can clinical staging replace CD4 monitoring?

Accepted Answer

No. Clinical staging is less sensitive than CD4 count for detecting disease progression. In an asymptomatic patient (stage 1), the CD4 count may already be <350 cells/μL, indicating need for ART initiation. Clinical staging complements but does not replace laboratory monitoring where available.

Question 2

How does WHO staging guide co-trimoxazole prophylaxis?

Accepted Answer

WHO recommends co-trimoxazole prophylaxis for adults and children with WHO clinical stage 3 or 4, or any stage if CD4 <350 cells/μL (adults) or age-appropriate CD4 threshold (children). Prophylaxis can be discontinued when CD4 >350 cells/μL for ≥6 months on ART.

Question 3

Is pulmonary TB always stage 3?

Accepted Answer

Yes — pulmonary TB is one of the most common stage-3-defining conditions. Extrapulmonary TB (lymph node, miliary, CNS, bone) is stage 4 by WHO classification. All patients with TB and HIV should start ART as soon as possible (generally within 2 weeks of TB treatment initiation, or within 8 weeks in patients with profound immunosuppression).