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8th Annual Conference Of The British HIV Association [BHIVA]19 – 21 April 2002, University of York, York |
[AUTHOR(S):] P Hay1, H Green2, D Dunn2, A Babiker2 on behalf of STOPIT
1 St George's Hospital and 2 Medical Research Council Clinical Trials Unit, London
BHIVA Conf 2002 Apr 19-21;8:O28
OBJECTIVE: To assess whether it is safe to discontinue prophylaxis (primary or secondary) for opportunistic infections (OIs) following a good immunological/virological response to highly active antiretroviral therapy (HAART).
METHODS: Participating clinical sites (n=37) prospectively identified patients in whom the discontinuation of prophylaxis for any OI was considered to be clinically indicated, due to a sufficiently high CD4 count or sufficiently low viral load, although levels were not predefined. A follow-up report was subsequently sent every 6 months.
RESULTS: Prophylaxis for Pneumocystis carinii pneumonia (PCP) was withdrawn in 500 patients (410 primary, 90 secondary prophylaxis), for Mycobacterium avium complex (MAC) in 30 (15, 15), and for CMV in 13 (1, 12). The median CD4 count at discontinuation of PCP prophylaxis was 350 cells/µL (only 5% had <200). Values for MAC (median 180) and CMV (median 220) were lower. CD4 counts were generally maintained above accepted prophylaxis threshold levels during the follow-up period. Total follow-up to last report or re-continuation of prophylaxis was 791, 67 and 28 person-years for PCP, MAC and CMV, respectively. No cases of PCP were reported but one patient had a recurrence of MAC and one a recurrence of CMV retinitis. Corresponding incidence rates are 0.0 (upper 95% confidence limit 0.4), 1.5 (7.2), 3.6 (16.9) per 100 person-years.
CONCLUSIONS: The risk of developing OIs in the absence of prophylaxis is very low provided adequate CD4 count levels are maintained. This study lends support to recommendations that prophylaxis or maintenance for PCP, MAC and CMV is not necessary in the context of HAART.
PRESENTING AUTHOR: P Hay
020419
O28
Copyright © 2002 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD