PCP prophylaxis not needed in HIV patients who respond to HAART

By David Douglas

NEW YORK (Reuters Health) – Discontinuation of prophylaxis for Pneumocystis carinii pneumonia (PCP) in HIV-infected patients who have an adequate immune recovery while being treated with highly active antiretroviral therapy (HAART), prompts no increase in PCP episodes, according to researchers in Greece and the US.

Dr. John P. A. Ioannidis of the University of Ioannina School of Medicine and Dr. Thomas A. Trikalinos of Tufts University School of Medicine, Boston, performed a meta-analysis and decision analysis on trials investigating this approach. The findings appear in the December 1st issue of Clinical Infectious Diseases.

Altogether, the researchers examined 14 studies involving 3584 HIV-infected subjects who had stopped prophylaxis. In total, there were 8 cases of PCP during 3449 person-years, giving an incidence of 0.23 cases per 100 person-years.

Decision analysis indicated that mortality and time alive without immunodeficiency were similar during modeled continuation or discontinuation. Furthermore, discontinuation in patients receiving primary prophylaxis led to "slightly fewer episodes of PCP and fewer toxicity-related prophylaxis withdrawals."

Commenting on the findings, Dr. Ioannidis told Reuters Health that "what was considered in the past an indispensable intervention for patients with HIV-infection and immunodeficiency is clearly no longer needed once these patients have responded adequately to currently available antiretroviral therapy."

Even without prophylaxis, he added, "such patients should no longer be afraid of P. carinii pneumonia, an infection that has traditionally been a major problem for individuals with AIDS."

Clin Infect Dis 2001;33:1901-1909.

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