Discontinuation of primary prophylaxis in HIV-infected patients at high risk of Pneumocystis carinii pneumonia: prospective multicentre study

AIDS. 2001 Mar 9;15(4):501-7. doi: 10.1097/00002030-200103090-00009.

Abstract

Objectives: To assess the safety of discontinuation of primary prophylaxis in HIV-infected patients on antiretroviral combination therapy at high risk of developing Pneumocystis carinii pneumonia.

Design: Prospective multicentre study.

Patients and methods: The incidence of P. carinii pneumonia after discontinuation of primary prophylaxis was studied in 396 HIV-infected patients on antiretroviral combination therapy who experienced an increase in their CD4 cell count to at least 200 x 10(6)/l and 14% of total lymphocytes; the study population included 191 patients with a history of CD4 cell counts below 100 x 10(6)/l (245 person-years) and 144 patients with plasma HIV RNA above 200 copies/ml (215 person-years).

Results: There was one case of Pneumocystis pneumonia, an incidence of 0.18 per 100 person-years [95% confidence interval (CI), 0.005--1.0 per 100 person-years]. No case was diagnosed in groups with low nadir CD4 cell counts (95% CI, 0--1.2 per 100 person-years) or detectable plasma HIV RNA (95% CI, 0--1.4 per 100 person-years).

Conclusions: Discontinuation of primary prophylaxis against Pneumocystis pneumonia is safe in patients who have responded with a sustained increase in their CD4 cell count to antiretroviral combination therapy, irrespective of the CD4 cell count nadir and the viral load at the time of stopping prophylaxis.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Drug Therapy, Combination
  • HIV Infections / complications*
  • HIV Infections / immunology
  • HIV Infections / virology
  • Humans
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Pneumonia, Pneumocystis / prevention & control*
  • Prospective Studies
  • RNA, Viral / analysis
  • Risk Factors
  • T-Lymphocyte Subsets

Substances

  • Anti-HIV Agents
  • RNA, Viral