Discontinuation of Chemoprophylaxis against Pneumocystis carinii Pneumonia in Patients with HIV Infection

Discontinuation of Chemoprophylaxis against Pneumocystis carinii Pneumonia in Patients with HIV Infection

Bienvenido G. Yangco, MD, MPH;
Jennifer C. Von Bargen, BS;
Anne C. Moorman, BSN, MPH;
Scott D. Holmberg, MD, MPH; and
for the HIV Outpatient Study (HOPS) Investigators*

From the Infectious Disease Research Institute, Tampa, Florida; and Centers for Disease Control and Prevention, Atlanta, Georgia.

Abstract

Background: HIV-infected patients with sustained immunologic improvement from antiretroviral therapy may be able to discontinue chemoprophylaxis against Pneumocystis carinii pneumonia (PCP).

Objective: To compare PCP incidence in HIV-infected patients who had sustained CD4⁺ lymphocyte counts greater than 200 cells/mm³ and who either discontinued or continued PCP prophylaxis.

Design: Nonrandomized prospective cohort study.

Setting: 10 HIV clinics in eight U.S. cities.

Patients: 146 patients had follow-up visits for a mean of 18.2 months after discontinuation of PCP prophylaxis, and 345 patients who continued PCP prophylaxis had follow-up visits for a mean of 14.0 months.

Measurements: Incidence of PCP.

Results: Patients who discontinued PCP prophylaxis had higher maximum and minimum CD4⁺ cell counts and lower viral loads than patients who continued PCP prophylaxis. Pneumocystis carinii pneumonia did not develop in either group (upper 95% exact binomial confidence limit of incidence for those who discontinued PCP prophylaxis, 2.3/100 person-years).

Conclusions: Discontinuation of PCP chemoprophylaxis may be appropriate for some HIV-infected ambulatory patients.

*For members of the HIV Outpatient Study Investigators, see Appendix.

Article and Author Information

Acknowledgments: The authors thank Kathy Wood, APACHE Medical Systems, Inc., for continued technical support of this project and Jon Kaplan and Alan Greenberg of the Centers for Disease Control and Prevention for helpful advice and editorial suggestions.
Grant Support: By a Cooperative Agreement (U64/CCU5096889) between the Centers for Disease Control and Prevention and the Health Research Network of APACHE Medical Systems.
Requests for Single Reprints: Bienvenido G. Yangco, MD, MPH, 4728 North Habana Avenue, Suite 303, Tampa, FL 33614.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Dr. Yangco: 4728 North Habana Avenue, Suite 303, Tampa, FL 33614.
Ms. Moorman, Ms. Von Bargen, and Dr. Holmberg: CDC/DHAP, Mailstop E-45, Atlanta, GA 30333.
Author Contributions: Conception and design: B.G. Yangco, A.C. Moorman, S.D. Holmberg.
Analysis and interpretation of the data: J.C. Von Bargen, A.C. Moorman, S.D. Holmberg.
Drafting of the article: B.G. Yangco, S.D. Holmberg.
Critical revision of the article for important intellectual content: J.C. Von Bargen, S.D. Holmberg.
Final approval of the article: S.D. Holmberg.
Provision of study materials or patients: B.G. Yangco.
Statistical expertise: J.C. Von Bargen.
Obtaining of funding: S.D. Holmberg.
Administrative, technical, or logistic support: A.C. Moorman, S.D. Holmberg.
Collection and assembly of data: B.G. Yangco, A.C. Moorman.