 |
|
|
| |
PCP prophylaxis is not required with a CD4+ T cell count < 200 cells/uL when viral replication is effectively suppressed
|
| |
| |
The authors found if patients on HAART had HIV RNA <50 c/ml even if CD4 was <200 PCP did not develop...so they concluded perhaps PCP prophylaxus is not needed under these circumstances
Reported by Jules Levin
XVI Toronto Aug 2006
D'Egidio G.E.1, Kravcik S.1, Cooper C.L.1, Cameron D.W.1, Fergusson D.1, Angel J.B.1
1University of Ottawa and Ottawa Health Research Institute, Ottawa, Canada
Background: Treatment guidelines recommend discontinuation of PCP prophylaxis if, in response to antiretroviral therapy (ART), the CD4+ cell count increases and is sustained above 200 cells/uL. This implies that even in the setting of maximal viral suppression, PCP prophylaxis should be continued if the CD4+ cell count plateaus below 200 cells/uL, despite the lack of evidence to support this.
Objective: To determine the risk (or lack thereof) of developing PCP, associated with the discontinuation of PCP prophylaxis, in patients on effective ART and with CD4+ cell counts that have plateaued at <200 cells/uL.
Methods: We describe a cohort of HIV-infected patients on effective ART with sustained HIV RNA levels <50 copies/ml and CD4+ T cell counts that have plateaued at <200 cells/uL and who have discontinued PCP prophylaxis.
Results:
Seventeen patients with mean CD4+ cell count nadir of 57 cells/uL discontinued PCP prophylaxis. Ten patients had been taking daily Trimethoprim-sulfamethoxazole and seven were receiving monthly aerosolized pentamidine.
The mean CD4+ cell count at the time of discontinuation was 134 cells/uL.
To date, patients have been off PCP prophylaxis for a mean of 12.9 months (range 3-32 months) for a total of 219 patient months.
The current mean CD4+ cell count is 165 cells/uL.
To date, no patient has developed PCP.
This is significantly different from the risk of developing PCP with a CD4+ cell count of <200 cells/uL in untreated HIV infection (Rate Difference 9.2%; 95% CI: 5.7% to 12.8%; p<0.05)
Conclusion: PCP prophylaxis does not appear to be required with a CD4+ cell count <200 cells/uL if plasma viral replication is effectively suppressed. This illustrates a degree of immune recovery that occurs with virologic suppression that is not reflected in CD4+ T cell count and suggests that guidelines for PCP prophylaxis may need to be re-evaluated.
|
| |
|
|
|
|
|
