title: Discontinuing Pneumocystis jirovecii Pneumonia Prophylaxis in HIV-Infected Patients With a CD4 Cell Count <200 cells/mm3.
abstract: OBJECTIVE
  To review the evidence for discontinuing primary and secondary Pneumocystis jirovecii pneumonia (PJP) prophylaxis in HIV-infected patients with a CD4 count <200 cells/mm(3).
  
  
  METHODS
  We conducted a literature search in MEDLINE, EMBASE, Cochrane Library, Google Scholar, and the International Aids Society Library (up to August 2015) using the following key search terms: Pneumocystis jirovecii, pneumonia, human immunodeficiency virus, primary prophylaxis, secondary prophylaxis, and discontinuation.
  
  
  METHODS
  All English-language studies that evaluated discontinuation of primary and/or secondary PJP prophylaxis in HIV-infected patients with CD4 count <200 cells/mm(3) were included.
  
  
  RESULTS
  Five studies were identified, which varied in design, sample size, outcomes, and duration of follow-up. Three studies examined discontinuation of primary and secondary PJP prophylaxis; 1 study evaluated discontinuing primary PJP prophylaxis; and 1 study evaluated stopping secondary PJP prophylaxis. Two out of the 5 studies pooled data for all opportunistic infections. Overall, there was a low incidence of PJP among HIV-infected patients who discontinued primary PJP prophylaxis and were well controlled on antiretroviral therapy (ART).
  
  
  CONCLUSIONS
  Discontinuation of primary PJP prophylaxis appears to be safe in patients on combination ART with a suppressed HIV viral load and a CD4 count >100 cells/mm(3). Additional data are needed to support the safety of discontinuing secondary PJP prophylaxis. Decisions to discontinue PJP prophylaxis in patients with a CD4 count <200 cells/mm(3) should be done on an individual patient basis, taking into consideration clinical factors, including ongoing adherence to ART.
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Vaninder K
authors.initials: VK
authors.lastname: Sidhu
authors.affiliation: Royal Alexandra Hospital, Edmonton, Alberta, Canada.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Foisy
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada christine.hughes@ualberta.ca.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Hughes
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology / Q000517:prevention & control*; D000935:Antifungal Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D006801:Humans; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000382:microbiology / Q000517:prevention & control*; D011322:Primary Prevention; D055502:Secondary Prevention
chemical_list: D000935:Antifungal Agents
keywords: HIV/AIDS; Pneumocystis jirovecii pneumonia (PJP); discontinuation; prophylaxis