Pneumocystis carinii pneumonia following discontinuation of primary prophylaxis despite highly active antiretroviral therapy

There has been a dramatic decline in the prevalence of opportunistic infections, particularly Pneumocystis carinii pneumonia (PCP) since the introduction of highly active antiretroviral therapy (HAART). Recently published short-term observational data now support the view that primary and possibly s...

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Bibliographic Details
Published in:International journal of STD & AIDS 2000-01, Vol.11 (1), p.64-65
Main Authors: MAMMEN-TOBIN, A, MONTEIRO, E. F
Format: Article
Language:English
Subjects:
AIDS-Related Opportunistic Infections - drug therapy
AIDS-Related Opportunistic Infections - immunology
AIDS-Related Opportunistic Infections - prevention & control
AIDS/HIV
Anti-HIV Agents - therapeutic use
Anti-Infective Agents - therapeutic use
Biological and medical sciences
CD4 Lymphocyte Count
Human immunodeficiency virus
Human mycoses
Human viral diseases
Humans
Infectious diseases
Male
Medical sciences
Middle Aged
Mycoses
Mycoses of the respiratory system
Pneumocystis carinii
Pneumonia, Pneumocystis - drug therapy
Pneumonia, Pneumocystis - prevention & control
Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:There has been a dramatic decline in the prevalence of opportunistic infections, particularly Pneumocystis carinii pneumonia (PCP) since the introduction of highly active antiretroviral therapy (HAART). Recently published short-term observational data now support the view that primary and possibly secondary PCP prophylaxis should be discontinued following sustained immune restoration afforded by HAART. Weverling and colleagues studied 378 patients with advanced HIV on HAART. Primary and secondary PCP prophylaxis was discontinued when the CD4 count had risen and remained above 200 for over 6 months and viral load was below 10,000 copies/ml. They encountered no episodes of PCP during a total 247 person-years of follow up. Furrer et al. showed the same result amongst 262 patients who stopped primary PCP prophylaxis over a median follow up of 11.3 months. The CD4 count was sustained above 200 for a minimum of 12 weeks in this study. We describe a case of acute PCP following withdrawal of primary prophylaxis despite an apparently excellent immunological and virological response to HAART.
ISSN:0956-4624
1758-1052
DOI:10.1258/0956462001914805