A prospective study of discontinuing primary and secondary Pneumocystis carinii pneumonia prophylaxis after CD4 cell count increase to > 200 × 106/l

Publisher Website
Google Scholar
Abstract
To assess the incidence of Pneumocystis carinii pneumonia (PCP) after discontinuation of either primary or secondary prophylaxis. This was a prospective, non-randomized, non-blinded study. Twenty-five University-based AIDS Clinical Trials Group units. Participants either had a CD4 cell count ≤ 100 × 106/l at any time in the past and no history of confirmed PCP (group I; n = 144), or had a confirmed episode of PCP ≥ 6 months prior to study entry (group II; n = 129). All subjects had sustained CD4 cell counts > 200 × 106/l in response to antiretroviral therapy. Subjects discontinued PCP prophylaxis within 3 months or at the time of study entry. Evaluations for symptoms of PCP and CD4 cell counts were performed every 8 weeks. Prophylaxis was resumed if two consecutive CD4 cell counts were Main outcome measure(s) The main outcome was development of PCP. No cases of PCP occurred in 144 subjects (median follow-up, 82 weeks) in group I or in the 129 subjects (median follow-up, 63 weeks) in group II (95% upper confidence limits on the rates of 1.3 per 100 person-years and 1.96 per 100 person-years for groups I and II, respectively). Eight subjects (five in group I and three in group II) resumed PCP prophylaxis after two consecutive CD4 cell counts Conclusions The risk of developing initial or recurrent PCP after discontinuing prophylaxis is low in HIV-infected individuals who have sustained CD4 cell count increases in response to antiretroviral therapy. Neither lifelong primary nor secondary PCP prophylaxis is necessary.

This publication has 40 references indexed in Scilit: