Discontinuation of Chemoprophylaxis against Pneumocystis carinii Pneumonia in Patients with HIV Infection

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Abstract
HIV-infected patients with sustained immunologic improvement from antiretroviral therapy may be able to discontinue chemoprophylaxis against Pneumocystis carinii pneumonia (PCP). To compare PCP incidence in HIV-infected patients who had sustained CD4+ lymphocyte counts greater than 200 cells/mm3 and who either discontinued or continued PCP prophylaxis. Nonrandomized prospective cohort study. 10 HIV clinics in eight U.S. cities. 146 patients had follow-up visits for a mean of 18.2 months after discontinuation of PCP prophylaxis, and 345 patients who continued PCP prophylaxis had follow-up visits for a mean of 14.0 months. Incidence of PCP. Patients who discontinued PCP prophylaxis had higher maximum and minimum CD4+ cell counts and lower viral loads than patients who continued PCP prophylaxis. Pneumocystis carinii pneumonia did not develop in either group (upper 95% exact binomial confidence limit of incidence for those who discontinued PCP prophylaxis, 2.3/100 person-years). Discontinuation of PCP chemoprophylaxis may be appropriate for some HIV-infected ambulatory patients. *For members of the HIV Outpatient Study Investigators, see Appendix.