Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus-infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis.
Risk factors for the development of a first episode of Pneumocystis carinii pneumonia (PCP) were investigated in the Adult and Adolescent Spectrum of Disease Project, a medical record review study involving longitudinal follow-up of human immunodeficiency virus-infected adults in 9 US cities. Risk factors included decreasing CD4 lymphocyte count and history of AIDS-defining illness, non-P. carinii pneumonia, oral thrush, or unexplained fever for > or = 2 days; PCP prophylaxis was protective. PCP incidence/100 person-years of observation among persons not prescribed PCP prophylaxis was higher in those with CD4 lymphocyte counts < 250 cells/microL or CD4 cell percent < 14% (8.3; 95% confidence interval [CI], 7.7-9.0) than in persons with CD4 cell counts < 200 or history of thrush or fever, which constitute current criteria for prophylaxis against PCP (5.9; 95% CI, 5.5-6.4). Because of increased efficiency in capturing persons at highest risk, CD4 cell count < 250 or CD4 cell percent < 14% should be considered as criteria for prophylaxis against first episodes of PCP.
Kaplan
J E
JE
Division of HIV/AIDS Prevention-Surveillance and Epidemiology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jxk2@cdc.gov
Hanson
D L
DL
Navin
T R
TR
Jones
J L
JL
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral; D018890:Chemoprevention / Q000592:standards; D005260:Female; D005335:Fever of Unknown Origin; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000517:prevention & control*; D018570:Risk Assessment; D014481:United States