Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: Results from the Treat Asia HIV observational database

Poh Lian Lim, Jialun Zhou, Rossana A. Ditangco, Matthew G. Law, Thira Sirisanthana, Nagalingeswaran Kumarasamy, Yi Ming A. Chen, Praphan Phanuphak, Christopher Kc Lee, Vonthanak Saphonn, Shinichi Oka, Fujie Zhang, Jun Y. Choi, Sanjay Pujari, Adeeba Kamarulzaman, Patrick Ck Li, Tuti P. Merati, Evy Yunihastuti, Liesl Messerschmidt, Somnuek Sungkanuparph

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Pneumocystis jiroveci pneumonia (PCP) prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm 3. This study examines the proportion of patients in the TREAT Asia HIV Observational Database (TAHOD) receiving PCP prophylaxis, and its effect on PCP and mortality. Methods. TAHOD patients with prospective follow up had data extracted for prophylaxis using co-trimoxazole, dapsone or pentamidine. The proportion of patients on prophylaxis was calculated for each calendar year since 2003 among patients with CD4 counts of less than 200 cells/mm 3. The effect of prophylaxis on PCP and survival were assessed using random-effect Poisson regression models. Results: There were a total of 4050 patients on prospective follow up, and 90% of them were receiving combination antiretroviral therapy. Of those with CD4 counts of less than 200 cells/mm 3, 58% to 72% in any given year received PCP prophylaxis, predominantly co-trimoxazole. During follow up, 62 patients developed PCP (0.5 per 100 person-years) and 169 died from all causes (1.36/100 person-years). After stratifying by site and adjusting for age, CD4 count, CDC stage and antiretroviral treatment, those without prophylaxis had no higher risk of PCP, but had a significantly higher risk of death (incident rate ratio 10.8, p < 0.001). PCP prophylaxis had greatest absolute benefit in patients with CD4 counts of less than 50 cells/mm 3, lowering mortality rates from 33.5 to 6.3 per 100 person-years. Conclusions: Approximately two-thirds of TAHOD patients with CD4 counts of less than 200 cells/mm 3 received PCP prophylaxis. Patients without prophylaxis had significantly higher mortality, even in the era of combination ART. Although PCP may be under-diagnosed, these data suggest that prophylaxis is associated with important survival benefits.

Original languageEnglish
Article number1
JournalJournal of the International AIDS Society
Volume15
Issue number1
DOIs
Publication statusPublished - Jan 27 2012
Externally publishedYes

Fingerprint

Pneumocystis
Pneumocystis carinii
Pneumocystis Pneumonia
HIV
Databases
CD4 Lymphocyte Count
Mortality
Sulfamethoxazole Drug Combination Trimethoprim
Pentamidine
Dapsone
Survival
Centers for Disease Control and Prevention (U.S.)

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era : Results from the Treat Asia HIV observational database. / Lim, Poh Lian; Zhou, Jialun; Ditangco, Rossana A.; Law, Matthew G.; Sirisanthana, Thira; Kumarasamy, Nagalingeswaran; Chen, Yi Ming A.; Phanuphak, Praphan; Lee, Christopher Kc; Saphonn, Vonthanak; Oka, Shinichi; Zhang, Fujie; Choi, Jun Y.; Pujari, Sanjay; Kamarulzaman, Adeeba; Li, Patrick Ck; Merati, Tuti P.; Yunihastuti, Evy; Messerschmidt, Liesl; Sungkanuparph, Somnuek.

In: Journal of the International AIDS Society, Vol. 15, No. 1, 1, 27.01.2012.

Research output: Contribution to journalArticle

Lim, PL, Zhou, J, Ditangco, RA, Law, MG, Sirisanthana, T, Kumarasamy, N, Chen, YMA, Phanuphak, P, Lee, CK, Saphonn, V, Oka, S, Zhang, F, Choi, JY, Pujari, S, Kamarulzaman, A, Li, PC, Merati, TP, Yunihastuti, E, Messerschmidt, L & Sungkanuparph, S 2012, 'Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: Results from the Treat Asia HIV observational database', Journal of the International AIDS Society, vol. 15, no. 1, 1. https://doi.org/10.1186/1758-2652-15-1
Lim, Poh Lian ; Zhou, Jialun ; Ditangco, Rossana A. ; Law, Matthew G. ; Sirisanthana, Thira ; Kumarasamy, Nagalingeswaran ; Chen, Yi Ming A. ; Phanuphak, Praphan ; Lee, Christopher Kc ; Saphonn, Vonthanak ; Oka, Shinichi ; Zhang, Fujie ; Choi, Jun Y. ; Pujari, Sanjay ; Kamarulzaman, Adeeba ; Li, Patrick Ck ; Merati, Tuti P. ; Yunihastuti, Evy ; Messerschmidt, Liesl ; Sungkanuparph, Somnuek. / Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era : Results from the Treat Asia HIV observational database. In: Journal of the International AIDS Society. 2012 ; Vol. 15, No. 1.
@article{d7b5eae6cb574214938ed3aa7d3e97b4,
title = "Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: Results from the Treat Asia HIV observational database",
abstract = "Background: Pneumocystis jiroveci pneumonia (PCP) prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm 3. This study examines the proportion of patients in the TREAT Asia HIV Observational Database (TAHOD) receiving PCP prophylaxis, and its effect on PCP and mortality. Methods. TAHOD patients with prospective follow up had data extracted for prophylaxis using co-trimoxazole, dapsone or pentamidine. The proportion of patients on prophylaxis was calculated for each calendar year since 2003 among patients with CD4 counts of less than 200 cells/mm 3. The effect of prophylaxis on PCP and survival were assessed using random-effect Poisson regression models. Results: There were a total of 4050 patients on prospective follow up, and 90{\%} of them were receiving combination antiretroviral therapy. Of those with CD4 counts of less than 200 cells/mm 3, 58{\%} to 72{\%} in any given year received PCP prophylaxis, predominantly co-trimoxazole. During follow up, 62 patients developed PCP (0.5 per 100 person-years) and 169 died from all causes (1.36/100 person-years). After stratifying by site and adjusting for age, CD4 count, CDC stage and antiretroviral treatment, those without prophylaxis had no higher risk of PCP, but had a significantly higher risk of death (incident rate ratio 10.8, p < 0.001). PCP prophylaxis had greatest absolute benefit in patients with CD4 counts of less than 50 cells/mm 3, lowering mortality rates from 33.5 to 6.3 per 100 person-years. Conclusions: Approximately two-thirds of TAHOD patients with CD4 counts of less than 200 cells/mm 3 received PCP prophylaxis. Patients without prophylaxis had significantly higher mortality, even in the era of combination ART. Although PCP may be under-diagnosed, these data suggest that prophylaxis is associated with important survival benefits.",
author = "Lim, {Poh Lian} and Jialun Zhou and Ditangco, {Rossana A.} and Law, {Matthew G.} and Thira Sirisanthana and Nagalingeswaran Kumarasamy and Chen, {Yi Ming A.} and Praphan Phanuphak and Lee, {Christopher Kc} and Vonthanak Saphonn and Shinichi Oka and Fujie Zhang and Choi, {Jun Y.} and Sanjay Pujari and Adeeba Kamarulzaman and Li, {Patrick Ck} and Merati, {Tuti P.} and Evy Yunihastuti and Liesl Messerschmidt and Somnuek Sungkanuparph",
year = "2012",
month = "1",
day = "27",
doi = "10.1186/1758-2652-15-1",
language = "English",
volume = "15",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",
number = "1",

}

TY - JOUR

T1 - Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era

T2 - Results from the Treat Asia HIV observational database

AU - Lim, Poh Lian

AU - Zhou, Jialun

AU - Ditangco, Rossana A.

AU - Law, Matthew G.

AU - Sirisanthana, Thira

AU - Kumarasamy, Nagalingeswaran

AU - Chen, Yi Ming A.

AU - Phanuphak, Praphan

AU - Lee, Christopher Kc

AU - Saphonn, Vonthanak

AU - Oka, Shinichi

AU - Zhang, Fujie

AU - Choi, Jun Y.

AU - Pujari, Sanjay

AU - Kamarulzaman, Adeeba

AU - Li, Patrick Ck

AU - Merati, Tuti P.

AU - Yunihastuti, Evy

AU - Messerschmidt, Liesl

AU - Sungkanuparph, Somnuek

PY - 2012/1/27

Y1 - 2012/1/27

N2 - Background: Pneumocystis jiroveci pneumonia (PCP) prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm 3. This study examines the proportion of patients in the TREAT Asia HIV Observational Database (TAHOD) receiving PCP prophylaxis, and its effect on PCP and mortality. Methods. TAHOD patients with prospective follow up had data extracted for prophylaxis using co-trimoxazole, dapsone or pentamidine. The proportion of patients on prophylaxis was calculated for each calendar year since 2003 among patients with CD4 counts of less than 200 cells/mm 3. The effect of prophylaxis on PCP and survival were assessed using random-effect Poisson regression models. Results: There were a total of 4050 patients on prospective follow up, and 90% of them were receiving combination antiretroviral therapy. Of those with CD4 counts of less than 200 cells/mm 3, 58% to 72% in any given year received PCP prophylaxis, predominantly co-trimoxazole. During follow up, 62 patients developed PCP (0.5 per 100 person-years) and 169 died from all causes (1.36/100 person-years). After stratifying by site and adjusting for age, CD4 count, CDC stage and antiretroviral treatment, those without prophylaxis had no higher risk of PCP, but had a significantly higher risk of death (incident rate ratio 10.8, p < 0.001). PCP prophylaxis had greatest absolute benefit in patients with CD4 counts of less than 50 cells/mm 3, lowering mortality rates from 33.5 to 6.3 per 100 person-years. Conclusions: Approximately two-thirds of TAHOD patients with CD4 counts of less than 200 cells/mm 3 received PCP prophylaxis. Patients without prophylaxis had significantly higher mortality, even in the era of combination ART. Although PCP may be under-diagnosed, these data suggest that prophylaxis is associated with important survival benefits.

AB - Background: Pneumocystis jiroveci pneumonia (PCP) prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm 3. This study examines the proportion of patients in the TREAT Asia HIV Observational Database (TAHOD) receiving PCP prophylaxis, and its effect on PCP and mortality. Methods. TAHOD patients with prospective follow up had data extracted for prophylaxis using co-trimoxazole, dapsone or pentamidine. The proportion of patients on prophylaxis was calculated for each calendar year since 2003 among patients with CD4 counts of less than 200 cells/mm 3. The effect of prophylaxis on PCP and survival were assessed using random-effect Poisson regression models. Results: There were a total of 4050 patients on prospective follow up, and 90% of them were receiving combination antiretroviral therapy. Of those with CD4 counts of less than 200 cells/mm 3, 58% to 72% in any given year received PCP prophylaxis, predominantly co-trimoxazole. During follow up, 62 patients developed PCP (0.5 per 100 person-years) and 169 died from all causes (1.36/100 person-years). After stratifying by site and adjusting for age, CD4 count, CDC stage and antiretroviral treatment, those without prophylaxis had no higher risk of PCP, but had a significantly higher risk of death (incident rate ratio 10.8, p < 0.001). PCP prophylaxis had greatest absolute benefit in patients with CD4 counts of less than 50 cells/mm 3, lowering mortality rates from 33.5 to 6.3 per 100 person-years. Conclusions: Approximately two-thirds of TAHOD patients with CD4 counts of less than 200 cells/mm 3 received PCP prophylaxis. Patients without prophylaxis had significantly higher mortality, even in the era of combination ART. Although PCP may be under-diagnosed, these data suggest that prophylaxis is associated with important survival benefits.

UR - http://www.scopus.com/inward/record.url?scp=84862780931&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862780931&partnerID=8YFLogxK

U2 - 10.1186/1758-2652-15-1

DO - 10.1186/1758-2652-15-1

M3 - Article

C2 - 22281054

AN - SCOPUS:84862780931

VL - 15

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

IS - 1

M1 - 1

ER -