Discontinuation of secondary prophylaxis for Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients: a randomized trial by the CIOP Study Group.
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.
Mussini
Cristina
C
Clinic of Infectious and Tropical Diseases, Azienda Ospedaliera Policlinico, University of Modena and Reggio Emilia, Modena, Italy. crimuss@unimo.it
Pezzotti
Patrizio
P
Antinori
Andrea
A
Borghi
Vanni
V
Monforte
Antonella d'Arminio
Ad
Govoni
Alessandra
A
De Luca
Andrea
A
Ammassari
Adriana
A
Mongiardo
Nicola
N
Cerri
Maria Chiara
MC
Bedini
Andrea
A
Beltrami
Cristina
C
Ursitti
Maria Alessandra
MA
Bini
Teresa
T
Cossarizza
Andrea
A
Esposito
Roberto
R
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*
D000935:Antifungal Agents