Discontinuation of chemoprophylaxis against Pneumocystis carinii pneumonia in patients with HIV infection. HIV Outpatient Study (HOPS) Investigators.
BACKGROUND
HIV-infected patients with sustained immunologic improvement from antiretroviral therapy may be able to discontinue chemoprophylaxis against Pneumocystis carinii pneumonia (PCP).


OBJECTIVE
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.


METHODS
Nonrandomized prospective cohort study.


METHODS
10 HIV clinics in eight U.S. cities.


METHODS
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.


METHODS
Incidence of PCP.


RESULTS
Patients who discontinued PCP prophylaxis had higher maximum and minimum CD4+ cell counts and lower vira 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).


CONCLUSIONS
Discontinuation of PCP chemoprophylaxis may be appropriate for some HIV-infected ambulatory patients.
Yangco
B G
BG
Infectious Disease Research Institute, Tampa, Florida, USA.
Von Bargen
J C
JC
Moorman
A C
AC
Holmberg
S D
SD
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018890:Chemoprevention; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology*; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D019562:Viral Load
D019380:Anti-HIV Agents; D000935:Antifungal Agents; D011480:Protease Inhibitors