Long-term safety of discontinuation of secondary prophylaxis against Pneumocystis pneumonia: prospective multicentre study.
OBJECTIVE
To assess the long-term safety of discontinuation of secondary anti-Pneumocystis prophylaxis in HIV-infected adults treated with antiretroviral combination therapy and who have a sustained increase in CD4 cell counts.


METHODS
Prospective observational multicentre study.


METHODS
The incidence of P. jirovecii pneumonia after discontinuation of secondary prophylaxis was studied in 78 HIV-infected patients on antiretroviral combination therapy after they experienced a sustained increase in CD4 cell counts to at least 200 x 10(6) cells/l and 14% of total lymphocytes measured twice at least 12 weeks apart.


RESULTS
Secondary prophylaxis was discontinued at a median CD4 cell count of 380 x 10(6) cells/l. The median follow-up period after discontinuation of secondary prophylaxis was 40.2 months, yielding a total of 235 person-years of follow-up. No cases of recurrent P. jirovecii pneumonia occurred during this period. The incidence was thus 0 per 100 person-years with a 95% upper of confidence limit of 1.3 cases per 100 patient-years.


CONCLUSIONS
Discontinuation of secondary prophylaxis against P. jirovecii pneumonia is safe even in the long term in patients who have a sustained immunologic response on antiretroviral combination therapy.
Zellweger
Claudine
C
Division of Infectious Diseases, University Hospital of Berne, Berne, Switzerland.
Opravil
Milos
M
Bernasconi
Enos
E
Cavassini
Matthias
M
Bucher
Heiner C
HC
Schiffer
Veronique
V
Wagels
Thomas
T
Flepp
Markus
M
Rickenbach
Martin
M
Furrer
Hansjakob
H
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000517:prevention & control*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000517:prevention & control*; D011446:Prospective Studies; D055502:Secondary Prevention; D028761:Withholding Treatment