Discontinuation of primary and secondary prophylaxis for opportunistic infections in HIV-infected patients who had CD4+ cell count <200 cells/mm(3) but undetectable plasma HIV-1 RNA: an open-label randomized controlled trial.
Abstract   The CDC recommends discontinuing opportunistic infections (OIs) prophylaxis in HIV-infected patients who have CD4+ cell count >200 cells/mm(3) after receiving combination antiretroviral therapy (cART). A prospective randomized controlled trial was conducted at Chiang Mai University Hospital from June 1, 2009 to January 31, 2012 in 74 adult HIV-infected patients who had received cART and had CD4+ cell count <200 cells/mm(3) but plasma HIV-1 RNA<50 copies/ml. Forty-three patients (58.1%) were male and the mean age was 41.8±8.1 years; 68 (91.9%) and 59 (79.7%) patients were receiving co-trimoxazole and antifungal prophylaxis, respectively. The median CD4+ cell counts at enrollment were 142 (IQR 108, 161) and 158 (IQR 141, 176) cells/mm(3) among patients who discontinued and continued OIs prophylaxis, respectively (p value=0.041). One of 37 patients (2.7%) in the discontinuation group developed Pneumocystis jiroveci pneumonia, giving the incidence rate of 1.57/1000 person-months. None of the 37 patients in the continuation group developed OIs. The difference in the prevention rates of OIs between groups was -2.7% (95% CI -7.9, 2.5). In conclusion, in the setting where plasma HIV-RNA measurement is available, e.g., Asia-Pacific region, discontinuation of prophylaxis is considerably safe in HIV-infected patients receiving cART with undetectable plasma HIV-RNA but incomplete immune recovery.
Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. rchaiwar@gmail.com
Romanee
R
Chaiwarith
Jutarat
J
Praparattanapan
Nontakan
N
Nuntachit
Wilai
W
Kotarathitithum
Khuanchai
K
Supparatpinyo
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D056990:Post-Exposure Prophylaxis; D011322:Primary Prevention; D011446:Prospective Studies; D012367:RNA, Viral / Q000302:isolation & purification; D055502:Secondary Prevention; D013785:Thailand / Q000453:epidemiology; D019562:Viral Load; D028761:Withholding Treatment
D019380:Anti-HIV Agents; D012367:RNA, Viral