Observational studyJournal of the International AIDS Society2021
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.
Observational study in Journal of the International AIDS Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Major revision version 11.0 of the European AIDS Clinical Society Guidelines 2021.HIV medicine · 2022Guideline
- Rezafungin as Primary Prophylaxis ofJournal of fungi (Basel, Switzerland) · 2026Article
- Two-threshold defined immune non-responders are associated with long-term morbidity in people with HIV: a prospective cohort study.Emerging microbes & infections · 2025Article
- Insights into Pneumocystis jirovecii pneumonia in South Africa (2018-2022).Medical mycology · 2025Article
- Management of Antiretroviral Therapy and Opportunistic Infections in People Living with HIV Undergoing Hematopoietic Stem Cell Transplant in British Columbia.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2024Article
- Review
- Diagnostic values of BALF metagenomic next-generation sequencing, BALF real-time PCR and serum BDG forFrontiers in microbiology · 2024Article
- HIV replication and tuberculosis risk among people living with HIV in Europe: A multicohort analysis, 1983-2015.PloS one · 2024Article
- Protocol for the systematic review of the Pneumocystis jirovecii-associated pneumonia in non-HIV immunocompromised patients.PloS one · 2024Article
- The Pathogenesis and Diagnosis ofJournal of fungi (Basel, Switzerland) · 2022Review
- Exploring the Differences in Pneumocystis Pneumonia Infection Between HIV and Non-HIV Patients.Cureus · 2022Review
- Alterations in the gut microbiota of AIDS patients with pneumocystis pneumonia and correlations with the lung microbiota.Frontiers in cellular and infection microbiology · 2022Article
- 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.Journal of the International AIDS Society · 2021Observational
Corrections and comments
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Authors and funding
17 authors at 13 institutions in 12 countries.
Funding
Abstract
introductionSince 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.
methodsWe 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).
resultsThere 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).
conclusionsHIV 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.
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