title: Long-term safety of discontinuation of secondary prophylaxis against Pneumocystis pneumonia: prospective multicentre study.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, University Hospital of Berne, Berne, Switzerland.
authors.forename: Claudine
authors.initials: C
authors.lastname: Zellweger
authors.forename: Milos
authors.initials: M
authors.lastname: Opravil
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Veronique
authors.initials: V
authors.lastname: Schiffer
authors.forename: Thomas
authors.initials: T
authors.lastname: Wagels
authors.forename: Markus
authors.initials: M
authors.lastname: Flepp
authors.forename: Martin
authors.initials: M
authors.lastname: Rickenbach
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
mesh_terms: 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