Can chemoprophylaxis against opportunistic infections be discontinued after an increase in CD4 cells induced by highly active antiretroviral therapy?
Kirk, O.; Lundgren, J.D.; Pedersen, C.; Nielsen, H.; Gerstoft, J.
Aids 13(13): 1647-1651
1999
ISSN/ISBN: 0269-9370 PMID: 10509565 DOI: 10.1097/00002030-199909100-00007Document Number: 533852
The incidences of opportunistic infections after discontinuation of chemoprophylaxis in HIV-infected patients from Denmark, who have experienced a highly active antiretroviral therapy (HAART)-induced increase in CD4 cell count, were assessed. The Danish guidelines for chemoprophylaxis against opportunistic infections in HIV-infected patients were revised in late 1997, allowing discontinuation of chemoprophylaxis after initiation of HAART if the CD4 cell count remained above a specified limit for >6 months. Consecutive patients were followed, and incidences of opportunistic infections after discontinuation of chemoprophylaxis were assessed. A total of 219 patients discontinued Pneumocystis carinii pneumonia (PCP)-chemoprophylaxis (12% maintenance therapy). One case of PCP was diagnosed within 174 person-years (PY) of follow-up, resulting in an incidence of 0.6 cases/100 PY follow-up (95% confidence interval, 0.0-3.2). No cases of cerebral toxoplasmosis, cytomegalovirus chorioretinitis or disseminated Mycobacterium avium infection were observed. Follow-up time for these was, however, limited. It is concluded that PCP-chemoprophylaxis can be safely discontinued after HAART-induced increase in CD4 cell count to >200x106 cells/litre. Among consecutive patients who discontinue chemoprophylaxis according to well-defined guidelines, the observed incidence of PCP is below those reported earlier in patients with similar CD4 cell count.