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

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25 引文 斯高帕斯(Scopus)

摘要

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.
原文英語
文章編號1
期刊Journal of the International AIDS Society
15
發行號1
DOIs
出版狀態已發佈 - 1月 27 2012
對外發佈

ASJC Scopus subject areas

  • 公共衛生、環境和職業健康
  • 傳染性疾病

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