AEGiS-13IAC: Can secondary pneumocystis carinii pneumonia (PCP) prophylaxis be discontinued in HIV-infected patients treated with highly active antiretroviral therapy(HAART)?

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Can secondary pneumocystis carinii pneumonia (PCP) prophylaxis be discontinued in HIV-infected patients treated with highly active antiretroviral therapy(HAART)?

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB360)

Abgrall S, Matheron S, Le Moing V, Dupont C, Costagliola D
S. Abgrall, Inserm SC4, Faculte Saint-Antoine, 27 Rue Chaligny, 75 571 Paris Cedex 12, France, Tel.: +331 447 384 59, Fax: +331 430 739 57, E-mail: abgrall@b3e.jussieu.fr

BACKGROUND: To assess incidence and risk factors for PCP recurrence in a cohort of HIV-patients treated with HAART.

METHODS: The FHDH is a prospective cohort of 70224 subjects. This study included the 485 patients treated with HAART while on PCP maintenance prophylaxis after a first episode observed between 1 January 1995 and 31 December 1998. Data from the database up to 31 December 1998 were monitored in each center from patients clinical records. Monitored data were available for 451 patients. Multivariate Cox model with time dependent covariates was used for the analysis.

RESULTS: Median CD4+ count was 32/mm³ at first PCP and 41/mm³ at HAART initiation. PCP recurred in 18 patients within 771 person-years (PY) of follow-up (Incidence rate (IR) 2.33 cases/100 PY; 95%CI, 1.26-3.41). CD4+ count increased > 200/mm³ in 274 patients (61%), 51 of whom (19%) stopped PCP prophylaxis, after a median follow-up of respectively 4 months and 19 months under HAART. None of these patients presented with recurrence within respectively 363 PY of follow-up after increase in CD4+ count > 200/mm³ (IR 0 case/100 PY; 95% CI, 0.00-0.82) and 37 PY of follow-up after discontinuation of prophylaxis and increase in their CD4+ count (IR 0 case/100 PY; 95% CI, 0.00-7.84). CD4+ count remained é ú 200/mm³ in 177 patients (39%), 9 of whom (5%) stopped prophylaxis. Multivariate analysis within the 177 patients remaining é ú 200 CD4/mm³ , showed that the discontinuation of maintenance prophylaxis (HR 19.13, p > 0.0001), and smaller rate of increase or no increase in successive CD4+ counts (HR 2.33 per 50 cells/mm³ decrease, p > 0.007) were associated with PCP recurrence.

CONCLUSION: Stopping secondary PCP prophylaxis appears to be safe in patients receiving HAART with a sustained increase in their CD4+ count to at least 200/mm³. When CD4+ count remains é ú 200/mm³ , continuation of secondary PCP prophylaxis is necessary to avoid PCP recurrence.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Pneumonia, Pneumocystis, HIV Infections, CD4 Lymphocyte Count, Incidence, Drug Therapy, Combination, HIV Seropositivity, Risk Factors, Chemoprevention, Human, prevention & control, pathogenicity, therapy, drug therapy
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