Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Multicenter AIDS Cohort Study
A. J. Saah, D. R. Hoover, Y. Peng, J. P. Phair, B. Visscher, L. A. Kingsley and L. K. Schrager
Johns Hopkins University, School of Public Health, Baltimore, Md., 21205, USA.
OBJECTIVE--To identify clinical and epidemiological factors associated with
failure of Pneumocystis carinii pneumonia (PCP) prophylaxis in those
receiving primary and secondary prophylaxis. DESIGN--Longitudinal cohort
study of participants infected with human immunodeficiency virus type 1 in
the Multicenter AIDS Cohort Study who used PCP prophylaxis regimens after
their T-helper lymphocyte counts had decreased to less than 0.200 x 10(9)/L
(200/microL). MAIN OUTCOME MEASURE--Occurrence or recurrence of PCP.
RESULTS--A total of 476 participants reported taking one or more of the
following regimens: trimethoprim-sulfamethoxazole (TMP-SMX), dapsone,
and/or aerosolized pentamidine--367 as primary prophylaxis and 109 as
secondary prophylaxis after a previous episode of PCP. A total of 92 (20%)
developed PCP despite prophylaxis. The mean failure rates per person-year
of follow-up were 16.0% for those receiving primary prophylaxis and 12.1%
for those receiving secondary prophylaxis (P = .19). Median times to death
after initiation of primary or secondary prophylaxis were 2.0 and 1.2
years, respectively. The main predictor for failure of PCP prophylaxis was
profound T-helper lymphocytopenia; 86% of failures occurred after T-helper
cell counts decreased to less than 0.075 x 10(9)/L and 76% occurred after
counts decreased to less than 0.050 x 10(9)/L. In multivariate
time-dependent analysis, when compared with counts between 0.100 x 10(9)/L
and 0.200 x 10(9)/L, the risk ratio for failure with counts less than 0.050
x 10(9)/L was 2.90 (P < .001). Once T-helper cell counts were
considered, fever was the only other health status indicator that predicted
subsequent PCP (ie, a time-dependent risk ratio of 2.22; P = .01). Use of
TMP-SMX as the prophylaxis regimen was protective but did not eliminate
failure (ie, a time-dependent risk ratio of 0.55; P = .03).
CONCLUSIONS--These findings strongly support identifying improved methods
of PCP prophylaxis once T-helper cell counts decrease to less than 0.075 x
10(9)/L or 0.100 x 10(9)/L. Given this severe degree of immunosuppression,
an inherently more effective regimen against P carinii is required.
Pneumocystis murina Infection and Cigarette Smoke Exposure Interact To Cause Increased Organism Burden, Development of Airspace Enlargement, and Pulmonary Inflammation in Mice
Christensen et al.
Infect. Immun. 2008;76:3481-3490.
ABSTRACT
| FULL TEXT
Effect of Nicotine on Lung S-Adenosylmethionine and Development of Pneumocystis Pneumonia
Shivji et al.
J. Biol. Chem. 2005;280:15219-15228.
ABSTRACT
| FULL TEXT
Prevention of Infection Due to Pneumocystis spp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients
Rodriguez and Fishman
Clin. Microbiol. Rev. 2004;17:770-782.
ABSTRACT
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Risk Factors for Prophylaxis Failure in Patients Receiving Aerosol Pentamidine for Pneumocystis carinii Pneumonia Prophylaxis
Wei et al.
Chest 2001;119:1427-1433.
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Prognostic Markers of Short-term Mortality in AIDS-Associated Pneumocystis carinii Pneumonia
Benfield et al.
Chest 2001;119:844-851.
ABSTRACT
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Management and Prevention of Opportunistic Infections in the HIV-Infected Patient
Purdy
Journal of Pharmacy Practice 2000;13:475-498.
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Prevention of Infection Due to Pneumocystis carinii
Fishman
Antimicrob. Agents Chemother. 1998;42:995-1004.
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Antibody to Pneumocystis carinii Protects Rats and Mice from Developing Pneumonia
Bartlett et al.
CVI 1998;5:74-77.
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Trends in Infectious Diseases and Cancers among Persons Dying of HIV Infection in the United States from 1987 to 1992
Selik et al.
ANN INTERN MED 1995;123:933-936.
ABSTRACT
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CD4 Depletion Predicts PCP Prophylaxis Failure
AIDS Clin Care 1995;1995:6-6.
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