Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1-infected patients treated with highly active antiretroviral therapy

Background Prophylactic drugs for Pneumocystis carinii pneumonia (PCP) are strongly recommended for HIV-1-infected patients with CD4 cell counts of le ss than 200 cells/mu L. Because of the highly active antiretroviral therapy (HAART) currently available, we speculated that prophylaxis can be discont inued in patients with CD4 cell counts of more than 200 cells/mu L. Methods In this prospective observational study, PCP prophylaxis (primary o r secondary) was discontinued in HIV-1-infected patients whose CD4 cell cou nt had increased above 200 cells/mu L (documented twice with an interval of at least 1 month) as a result of HAART. Patients and their CD4 cell counts were monitored every 3 months. The primary endpoint of the study was the o ccurrence or reoccurrence of PCP. Findings 78 patients were enrolled: 62 patients were receiving prophylaxis for primary prevention of PCP and 16 patients for secondary prevention of P CP. At the time of discontinuation of prophylaxis, the mean CD4 cell count was 347 cells/mu L, and HIV-1-RNA was not detectable in 61 patients. The lo west mean CD4 cell count during prophylaxis was 79 cells/mu L. Patients sto pped prophylaxis 9.8 (SD 6.4) months after they started HAART, The mean fol low-up after discontinuation of prophylaxis was 12.7 (SD 7.6) months, and n one of the patients developed PCP (97.5% one-sided CI 0-4.4%). Interpretation The preliminary results of this study indicate that PCP prop hylaxis can be stopped safely in HIV-1-infected patients whose CD4 cell cou nts have increased above 200 cells/mu L after treatment with HAART.