| Abstract: | From June 1999 to June 2002, 134 HIV-1-infected patients (124 males; median age of 37 years), who had an initial CD4+ cell count<100/(L (median, 24/(L; range, 0-90/(L) and plasma viral load (PVL) of 428,500 copies/ml (range, <400 to >750,000) were enrolled in a prospective study, aiming to ascertain if primary and secondary prophylaxis against Pneumocystis carinii pneumonia (PCP) could be discontinued earlier than what is now recommended by the USPHS/IDSA guidelines, when they were receiving HAART. At enrollment, 54 patients had had previous PCP. At discontinuation, CD4+ has increased to 101/(L (range, 2-586/(L; 53.1%(100/(L) and median PVL decreased to <400 copies/ml (61.8%<400 copies/ml) after use of PCP prophylaxis for 4 months (range, 1 day to 42 months). As of 31 December, 2002, the median observation duration was 444 days following discontinuation of prophylaxis and the total observation duration was 172 patients-years (PY). Their latest median CD4+ count was 203/(L (range, 2-605/(L) and PVL<400 copies/ml (82.1%<400 copies/ml). Bacterial infections developed in 20 patients (incidence, 11.6 per 100 PY) and new opportunistic illnesses (OI) in 25 patients (14.52 per 100 PY). The new OI included herpes zoster (11 episodes), followed by disseminated mycobacteriosis other than tuberculosis (5), CMV disease (4), PCP (3; 1.74 per 100 PY), TB (3) and toxoplasmosis (1). The three patients, 2 with previous PCP and 1 without, who developed PCP and toxoplasmosis had poor adherence to HAART and HIV care, with virologic and immunologic failure despite HAART. We concluded that in HIV-1-infected patients whose CD4+ had increased to (100/(L, earlier discontinuation of PCP prophylaxis appeared to be safe and the risk for development of PCP was low, if they responded favorably to HAART. |
