title: Withdrawal of Pneumocystis jirovecii prophylaxis in HIV-infected children under highly active antiretroviral therapy.
abstract: OBJECTIVE
  In HIV-infected adults Pneumocystis jirovecii pneumonia (PCP) prophylaxis can be safely withdrawn after immune reconstitution due to the introduction of highly active antiretroviral therapy (HAART). With regard to children only a small amount of data has been published. The present study investigated whether the withdrawal of PCP prophylaxis after immune reconstitution is safe in HIV-infected children.
  
  
  METHODS
  A retrospective analysis at 10 European centers belonging to the Pediatric European Network on the treatment of AIDS (PENTA) using a standardized questionnaire.
  
  
  RESULTS
  A total of 113 questionnaires were received. In 82 children the indication for PCP prophylaxis was provided following Centers for Disease Control (CDC) guidelines (72 primary and 10 secondary). Prophylaxis was withdrawn after the CD4 cell count increased above the age-related CDC thresholds. The observation period off prophylaxis was 335 years (300 years for primary and 35 years for secondary prophylaxis) and the median time per patient off prophylaxis was 4.1 years (range, 0.3-7.7 years). No episode of PCP occurred during the study period. In comparison with the incidence rate from historical data before the introduction of PCP prophylaxis and HAART, this was a significant reduction (P < 0.05).
  
  
  CONCLUSIONS
  The increase in CD4 cell count provides functional reconstitution of the immune system in children. Our data suggests that the risk of developing a PCP after immune reconstitution is sufficiently low to withdraw PCP prophylaxis.
authors.affiliation: University Children's Hospital, Munich, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Urschel
authors.forename: Jose
authors.initials: J
authors.lastname: Ramos
authors.forename: Maria
authors.initials: M
authors.lastname: Mellado
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.forename: Gwenda
authors.initials: G
authors.lastname: Verweel
authors.forename: Tobias
authors.initials: T
authors.lastname: Schuster
authors.forename: Tim
authors.initials: T
authors.lastname: Niehues
authors.forename: Bernd
authors.initials: B
authors.lastname: Belohradsky
authors.forename: Uwe
authors.initials: U
authors.lastname: Wintergerst
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load
chemical_list: D000935:Antifungal Agents