title: A prospective study of discontinuing primary and secondary Pneumocystis carinii pneumonia prophylaxis after CD4 cell count increase to > 200 x 106 /l.
abstract: OBJECTIVE
  To assess the incidence of Pneumocystis carinii pneumonia (PCP) after discontinuation of either primary or secondary prophylaxis.
  
  
  METHODS
  This was a prospective, non-randomized, non-blinded study.
  
  
  METHODS
  Twenty-five University-based AIDS Clinical Trials Group units.
  
  
  METHODS
  Participants either had a CD4 cell count < or = 100 x 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 > or = 6 months prior to study entry (group II; n = 129). All subjects had sustained CD4 cell counts > 200 x 106/l in response to antiretroviral therapy.
  
  
  METHODS
  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 < 200 x 106/l.
  
  
  METHODS
  The main outcome was development of PCP.
  
  
  RESULTS
  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 < 200 x 106/l.
  
  
  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.
authors.affiliation: The Ohio State University Hospitals, Columbus, Ohio, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Koletar
authors.forename: A E
authors.initials: AE
authors.lastname: Heald
authors.forename: D
authors.initials: D
authors.lastname: Finkelstein
authors.forename: R
authors.initials: R
authors.lastname: Hafner
authors.forename: J S
authors.initials: JS
authors.lastname: Currier
authors.forename: J A
authors.initials: JA
authors.lastname: McCutchan
authors.forename: M
authors.initials: M
authors.lastname: Vallee
authors.forename: F J
authors.initials: FJ
authors.lastname: Torriani
authors.forename: W G
authors.initials: WG
authors.lastname: Powderly
authors.forename: R J
authors.initials: RJ
authors.lastname: Fass
authors.forename: R L
authors.initials: RL
authors.lastname: Murphy
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents