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

• 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
• ISSN: 0956-4624; 1758-1052
• DOI: 10.1258/0956462001914805

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.