title: The role of CD4 cell count as discriminatory measure to guide chemoprophylaxis against Pneumocystis jirovecii pneumonia in human immunodeficiency virus-negative immunocompromised patients: A systematic review.
abstract: BACKGROUND
  In recent years, the incidence of Pneumocystis jirovecii pneumonia (PJP) has increased in immunocompromised patients without human immunodeficiency virus (HIV) infection. Chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is highly effective in preventing PJP in both HIV-positive and -seronegative patients. In HIV-positive patients, the risk of PJP is strongly correlated with decreased CD4 cell count. The role of CD4 cell count in the pathogenesis of PJP in non-HIV immunocompromised patients is less well studied. For most immunosuppressive conditions, no clear guidelines indicate whether to start TMP-SMX.
  
  
  METHODS
  We conducted a systematic literature review with the aim to provide a comprehensive overview on the role of CD4 cell counts in managing the risk of PJP in HIV-seronegative patients.
  
  
  RESULTS
  Of the 63 individual studies retrieved, 14 studies report on CD4 cell counts in a variety of immunosuppressive conditions. CD4 cell count were <200/μL in 73.1% of the patients.
  
  
  CONCLUSIONS
  CD4 cell count <200/μL is a sensitive biomarker to identify non-HIV immunocompromised patients who are at risk for PJP. Measuring CD4 cell counts could help clinicians identify patients who may benefit from TMP-SMX prophylaxis.
authors.affiliation: Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.|Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Messiaen
authors.affiliation: Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.
authors.forename: Senne
authors.initials: S
authors.lastname: Cuyx
authors.affiliation: Department of Nephrology, Jessa Hospital, Hasselt, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Dejagere
authors.affiliation: Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.|Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium.
authors.forename: Jeroen C
authors.initials: JC
authors.lastname: van der Hilst
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D018791:CD4 Lymphocyte Count; D018023:HIV Seronegativity / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000009:adverse effects; D045363:Pneumocystis carinii / Q000187:drug effects* / Q000472:pathogenicity; D011020:Pneumonia, Pneumocystis / Q000276:immunology* / Q000382:microbiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: 
  PJP
  ; 
  Pneumocystis
  ; CD4 cell count; TMP-SMX; non-HIV