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Title: Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: Results from the Treat Asia HIV observational database
Authors: 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
Tan Tock Seng Hospital
University of New South Wales (UNSW) Australia
Chiang Mai University
YR Gaitonde Centre for AIDS Research and Education
National Yang-Ming University Taiwan
The HIV Netherlands Australia Thailand Research Collaboration
Hospital Sungai Buloh
National Center for HIV/AIDS
National Center for Global Health and Medicine
Beijing Ditan Hospital
Yonsei University College of Medicine
Institute of Infectious Diseases
University of Malaya Medical Centre
Queen Elizabeth Hospital Hong Kong
Universitas Udayana
University of Indonesia, RSUPN Dr. Cipto Mangunkusumo
TREAT Asia/amfAR-The Foundation for AIDS Research
Mahidol University
Keywords: Medicine
Issue Date: 27-Jan-2012
Citation: Journal of the International AIDS Society. Vol.15, No.1 (2012)
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. © 2012 Lim et al; licensee BioMed Central Ltd.
ISSN: 17582652
Appears in Collections:Scopus 2011-2015

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