Wardle, D.M.; Kennedy, D.
June 2003
Sexually Transmitted Infections;Jun2003 Supplement 1, Vol. 79, pA22
Academic Journal
Introduction: We audited chemoprophylactic use against Pneumocystis carinii pneumonia (PCP) in our HIV+ patients using US Public Health Service and Infectious Diseases Society of America USPHS/IDSA guidelines as a standard in the absence of definitive UK guidelines. Methods: Criteria for patients on prophylaxis including most recent CD4 count, percentage, method of primary or secondary prophylaxis, and changes to initial choice were obtained from casenotes. The time interval since achieving the threshold of CD4 count >200 cells/µl and CD4 percentage ≥14% for at least three months were calculated. Results: 97 patients received PCP prophylaxis; 71% primary and 29% secondary. 79% met the standards of the US guidelines. One patient had primary prophylaxis discontinued despite the guidelines. In total, prophylaxis was extended beyond the discontinuation threshold for 268 months. The US recommended regime is co-trimoxazole 960 mg daily and was prescribed to 29% of our patients, with a further 55% on lower or less frequent dosing. Alternative regimes included monthly nebulised pentamidine (13%) and daily dapsone (3%). Prophylaxis had been changed in 37 cases, 17 with a documented reason. An adverse event with co-trimoxazole was documented in 14 cases and 2 were re-challenged. Three patients developed primary PCP with CD4 counts >200 cells/µl; 475 (16%), 449 (10%), and 291 (5%), respectively. Conclusion: The majority (79%) of patients receiving PCP prophylaxis met the standard. Up to 70% of patients experiencing adverse events with co-trimoxazole can be successfully re-challenged. This should be encouraged as co-trimoxazole 960 mg daily can confer cross protection against Toxoplasma gondii, 2 (14%) of our patients were successfully re-challenged. Continuation beyond the recommended guidelines adds little to prevention, cessation can simplify treatment, lower costs, reduce toxicity, and may facilitate adherence to antiretrovirals.


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