title: Discontinuation of secondary prophylaxis for Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients: a randomized trial by the CIOP Study Group.
abstract: This subgroup analysis assessing secondary prophylaxis for Pneumocystis carinii pneumonia (PCP) describes a multicenter, open-labeled, randomized, controlled trial evaluating the discontinuation of PCP prophylaxis. The main inclusion criterion was a history of PCP and an increase in the CD4 cell count to >200 cells/microL associated with receipt of highly active antiretroviral therapy for >or=3 months. The primary end point was the development of definitive or presumptive PCP. A total of 146 patients were enrolled (77 in the treatment discontinuation arm). After >2 years, 1 definitive and 1 presumptive case of PCP were observed, both of which occurred in patients who discontinued therapy. In most patients, secondary prophylaxis for PCP can be safely discontinued after potent antiretroviral therapy is initiated, but the threshold of >200 CD4 cells/microL may not be considered absolutely safe. Patients who present with symptoms after discontinuation of secondary prophylaxis should be evaluated for PCP despite high CD4 count and complete virus suppression.
authors.affiliation: Clinic of Infectious and Tropical Diseases, Azienda Ospedaliera Policlinico, University of Modena and Reggio Emilia, Modena, Italy. crimuss@unimo.it
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pezzotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Vanni
authors.initials: V
authors.lastname: Borghi
authors.forename: Antonella d'Arminio
authors.initials: Ad
authors.lastname: Monforte
authors.forename: Alessandra
authors.initials: A
authors.lastname: Govoni
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
authors.forename: Adriana
authors.initials: A
authors.lastname: Ammassari
authors.forename: Nicola
authors.initials: N
authors.lastname: Mongiardo
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Cerri
authors.forename: Andrea
authors.initials: A
authors.lastname: Bedini
authors.forename: Cristina
authors.initials: C
authors.lastname: Beltrami
authors.forename: Maria Alessandra
authors.initials: MA
authors.lastname: Ursitti
authors.forename: Teresa
authors.initials: T
authors.lastname: Bini
authors.forename: Andrea
authors.initials: A
authors.lastname: Cossarizza
authors.forename: Roberto
authors.initials: R
authors.lastname: Esposito
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018890:Chemoprevention; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*
chemical_list: D000935:Antifungal Agents