Ledergerber, B and Mocroft, AJ and Reiss, P and Furrer, H and Kirk, O and Bickel, M and Uberti-Foppa, C and Pradier, C and d'Arminio Monforte, A and Schneider, MM and Lundgren, JD (2001) Discontinuation of secondary prophylaxis against Pneumocystis carinii pneumonia in patients with HIV infection who have a response to antiretroviral therapy. Eight European Study Groups. New England Journal of Medicine , 344 (3) 168 - 174. 10.1056/NEJM200101183440302.
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BACKGROUND: Patients with human immunodeficiency virus (HIV) infection and a history of Pneumocystis carinii pneumonia are at high risk for relapse if they are not given secondary prophylaxis. Whether secondary prophylaxis against P. carinii pneumonia can be safely discontinued in patients who have a response to highly active antiretroviral therapy is not known. METHODS: We analyzed episodes of recurrent P. carinii pneumonia in 325 HIV-infected patients (275 men and 50 women) in eight prospective European cohorts. Between October 1996 and January 2000, these patients discontinued secondary prophylaxis during treatment with at least three anti-HIV drugs after they had at least one peripheral- blood CD4 cell count of more than 200 cells per cubic millimeter. RESULTS: Secondary prophylaxis was discontinued at a median CD4 cell count of 350 per cubic millimeter; the median nadir CD4 cell count had been 50 per cubic millimeter. The median duration of the increase in the CD4 cell count to more than 200 per cubic millimeter after discontinuation of secondary prophylaxis was 11 months. The median follow-up period after discontinuation of secondary prophylaxis was 13 months, yielding a total of 374 person-years of follow-up; for 355 of these person-years, CD4 cell counts remained at or above 200 per cubic millimeter. No cases of recurrent P. carinii pneumonia were diagnosed during this period; the incidence was thus 0 per 100 patient-years (99 percent confidence interval, 0 to 1.2 per 100 patient-years, on the basis of the entire follow-up period, and 0 to 1.3 per 100 patient- years, on the basis of the follow-up period during which CD4 cell counts remained at or above 200 per cubic millimeter). CONCLUSIONS: It is safe to discontinue secondary prophylaxis against P. carinii pneumonia in patients with HIV infection who have an immunologic response to highly active antiretroviral therapy
|Title:||Discontinuation of secondary prophylaxis against Pneumocystis carinii pneumonia in patients with HIV infection who have a response to antiretroviral therapy. Eight European Study Groups|
|Additional information:||UI - 21022203 LA - eng RN - 0 (Anti-Infective Agents) PT - Journal Article DA - 20010104 IS - 0028-4793 SB - AIM SB - IM CY - United States|
|Keywords:||1996, 99, ACTIVE ANTIRETROVIRAL THERAPY, adult, AGENT, AGENTS, AIDS-Related Opportunistic Infections, Anti HIV, Anti-Infective Agents, antiretroviral, antiretroviral therapy, Antiretroviral Therapy, Highly Active, ANTIRETROVIRAL-THERAPY, Blood, CD4, CD4 CELL COUNT, CD4 Lymphocyte Count, cell, Cell Count, CELL COUNTS, CELLS, COHORT, Cohort Studies, confidence, confidence interval, COUNT, COUNTS, CUBIC MILLIMETER, discontinuation, disease, DRUG, drug therapy, DRUGS, DURATION, epidemiology, EPISODE, EPISODES, european, Female, FOLLOW UP, Follow-up, groups, HIGH-RISK, highly active antiretroviral therapy, History, Hiv, HIV INFECTED PATIENTS, HIV INFECTION, HIV Infections, Hiv-1, HIV-INFECTED PATIENTS, HIV-INFECTION, Human immunodeficiency virus, HUMAN-IMMUNODEFICIENCY, HUMAN-IMMUNODEFICIENCY-VIRUS, IM, immunodeficiencies, immunodeficiency, Immunodeficiency Virus, immunology, Incidence, INCREASE, Infection, January, LA, Male, MEN, Methods, Middle Age, October, Patient, patients, PERIOD, peripheral, PERIPHERAL BLOOD, Pneumocystis, Pneumocystis carinii, Pneumocystis Carinii Pneumonia, Pneumonia, Pneumonia, Pneumocystis carinii, prevention & control, Prophylaxis, Recurrence, RECURRENT, RELAPSE, response, Result, Risk, SAFE, secondary, STATE, STATES, Support, Non-U.S.Gov't, therapeutic use, THERAPIES, therapy, treatment, united, United States, UNITED-STATES, VIRUS, WOMEN|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Infection and Population Health|
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