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Previous Volume 344:168-174 January 18, 2001 Number 3 Next

	Full Text PDF Editorial by Girard, P.-M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Patients with human immunodeficiency virus (HIV) infection and a history of Pneumocystis carinii pneumonia are at high risk for relapse if they are not given secondary prophylaxis. Whether secondary prophylaxis against P. carinii pneumonia can be safely discontinued in patients who have a response to highly active antiretroviral therapy is not known.

Methods We analyzed episodes of recurrent P. carinii pneumonia in 325 HIV-infected patients (275 men and 50 women) in eight prospective European cohorts. Between October 1996 and January 2000, these patients discontinued secondary prophylaxis during treatment with at least three anti-HIV drugs after they had at least one peripheral-blood CD4 cell count of more than 200 cells per cubic millimeter.

Results Secondary prophylaxis was discontinued at a median CD4 cell count of 350 per cubic millimeter; the median nadir CD4 cell count had been 50 per cubic millimeter. The median duration of the increase in the CD4 cell count to more than 200 per cubic millimeter after discontinuation of secondary prophylaxis was 11 months. The median follow-up period after discontinuation of secondary prophylaxis was 13 months, yielding a total of 374 person-years of follow-up; for 355 of these person-years, CD4 cell counts remained at or above 200 per cubic millimeter. No cases of recurrent P. carinii pneumonia were diagnosed during this period; the incidence was thus 0 per 100 patient-years (99 percent confidence interval, 0 to 1.2 per 100 patient-years, on the basis of the entire follow-up period, and 0 to 1.3 per 100 patient-years, on the basis of the follow-up period during which CD4 cell counts remained at or above 200 per cubic millimeter).

Conclusions It is safe to discontinue secondary prophylaxis against P. carinii pneumonia in patients with HIV infection who have an immunologic response to highly active antiretroviral therapy.

Source Information

From the Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland (B.L.); the Royal Free and University College Medical School, London (A.M.); the Division of Infectious Diseases, Tropical Medicine, and AIDS and the National AIDS Therapy Evaluation Center, Academic Medical Center, University of Amsterdam, Amsterdam (P.R.); the Division of Infectious Diseases, University Hospital Bern, Bern, Switzerland (H.F.); the Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark (O.K., J.D.L.); the Center of Internal Medicine, J.W. Goethe University, Frankfurt, Germany (M.B.); the Infectious Diseases Department, San Raffaele Hospital, Milan, Italy (C.U.-F.); the Tropical and Infectious Diseases Department, Hôpital l'Archet, Nice, France (C.P.); the Institute of Infectious and Tropical Diseases, University of Milan, Milan, Italy (A.d'A.M.); and the Department of Internal Medicine, Division of Infectious Diseases and AIDS, University Medical Center Utrecht, Utrecht, the Netherlands (M.M.E.S.). Presented in part at the 7th Conference on Retroviruses and Opportunistic Infections, January 30–February 2, 2000, San Francisco.

Address reprint requests to Dr. Ledergerber at the Division of Infectious Diseases, University Hospital, CH-8091 Zurich, Switzerland, or at infled{at}usz.unizh.ch.

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