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@article{1785277,
author = {Atkinson, Andrew and Miro, Jose M. and Mocroft, Amanda and Reiss, Peter and Kirk, Ole and Morlat, Philippe and Ghosn, Jade and Stephan, Christoph and Mussini, Cristina and Antoniadou, Anastasia and Doerholt, Katja and Girardi, Enrico and De Wit, Stéphane and Kraus, David and Zwahlen, Marcel and Furrer, Hansjakob},
article_number = {6},
doi = {http://dx.doi.org/10.1002/jia2.25726},
keywords = {opportunistic infections; Pneumocystis jirovecii pneumonia; prophylaxis},
language = {eng},
issn = {1758-2652},
journal = {Journal of the International AIDS Society},
title = {No need for secondary Pneumocystis jirovecii pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100 cells/µL},
url = {https://doi.org/10.1002/jia2.25726},
volume = {24},
year = {2021}
}
TY - JOUR
ID - 1785277
AU - Atkinson, Andrew - Miro, Jose M. - Mocroft, Amanda - Reiss, Peter - Kirk, Ole - Morlat, Philippe - Ghosn, Jade - Stephan, Christoph - Mussini, Cristina - Antoniadou, Anastasia - Doerholt, Katja - Girardi, Enrico - De Wit, Stéphane - Kraus, David - Zwahlen, Marcel - Furrer, Hansjakob
PY - 2021
TI - No need for secondary Pneumocystis jirovecii pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100 cells/µL
JF - Journal of the International AIDS Society
VL - 24
IS - 6
SP - "e25726"
EP - "e25726"
PB - John Wiley & Sons Ltd
SN - 17582652
KW - opportunistic infections
KW - Pneumocystis jirovecii pneumonia
KW - prophylaxis
UR - https://doi.org/10.1002/jia2.25726
N2 - Introduction Since the beginning of the HIV epidemic in resource-rich countries, Pneumocystis jirovecii pneumonia (PjP) is one of the most frequent opportunistic AIDS-defining infections. The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) has shown that primary Pneumocystis jirovecii Pneumonia (PjP) prophylaxis can be safely withdrawn in patients with CD4 counts of 100 to 200 cells/µL if plasma HIV-RNA is suppressed on combination antiretroviral therapy. Whether this holds true for secondary prophylaxis is not known, and this has proved difficult to determine due to the much lower population at risk. Methods We estimated the incidence of secondary PjP by including patient data collected from 1998 to 2015 from the COHERE cohort collaboration according to time-updated CD4 counts, HIV-RNA and use of PjP prophylaxis in persons >16 years of age. We fitted a Poisson generalized additive model in which the smoothed effect of CD4 was modelled by a restricted cubic spline, and HIV-RNA was stratified as low (<400), medium (400 to 10,000) or high (>10,000copies/mL). Results There were 373 recurrences of PjP during 74,295 person-years (py) in 10,476 patients. The PjP incidence in the different plasma HIV-RNA strata differed significantly and was lowest in the low stratum. For patients off prophylaxis with CD4 counts between 100 and 200 cells/µL and HIV-RNA below 400 copies/mL, the incidence of recurrent PjP was 3.9 (95% CI: 2.0 to 5.8) per 1000 py, not significantly different from patients on prophylaxis in the same stratum (1.9, 95% CI: 0.1 to 3.7). Conclusions HIV viraemia importantly affects the risk of recurrent PjP. In virologically suppressed patients on ART with CD4 counts of 100 to 200/µL, the incidence of PjP off prophylaxis is below 10/1000 py. Secondary PjP prophylaxis may be safely withheld in such patients. While European guidelines recommend discontinuing secondary PjP prophylaxis only if CD4 counts rise above 200 cells/mL, the latest US Guidelines consider secondary prophylaxis discontinuation even in patients with a CD4 count above 100 cells/µL and suppressed viral load. Our results strengthen and support this US recommendation.
ER -
ATKINSON, Andrew, Jose M. MIRO, Amanda MOCROFT, Peter REISS, Ole KIRK, Philippe MORLAT, Jade GHOSN, Christoph STEPHAN, Cristina MUSSINI, Anastasia ANTONIADOU, Katja DOERHOLT, Enrico GIRARDI, Stéphane DE WIT, David KRAUS, Marcel ZWAHLEN a Hansjakob FURRER. No need for secondary Pneumocystis jirovecii pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100 cells/µL. \textit{Journal of the International AIDS Society}. John Wiley \&{} Sons Ltd, 2021, roč.~24, č.~6, s.~''e25726'', 8 s. ISSN~1758-2652. Dostupné z: https://dx.doi.org/10.1002/jia2.25726.
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