Incidence of Pneumocystis carinii pneumonia in treatment-naïve HIV-infected adult patients receiving primary Pneumocystis carinii pneumonia chemoprophylaxis with 48-week antiretroviral initiation

Abstract

Objective: The objective of the study was to determine the incidence of primary Pneumocystis carinii pneumonia (PCP) between patients who received and did not receive primary PCP chemoprophylaxis and investigate adverse drug reactions (ADRs) related to the chemoprophylaxis use. Method: A retrospective study was conducted in Siriraj Hospital, Thailand. Data were collected from HIV-infected adults, initiated with highly active antiretroviral therapy (HAART) with initial CD4+ <200 cells/mm3. Results: Overall, 217 patients had a median initial CD4+ of 83 cells/mm3 (interquartile range: 33.5–150.5) (range: 0–199), most of the initial HAART regimen was non-nucleoside reverse transcriptase inhibitors based containing tenofovir disoproxil fumarate (94.94%), and 104 patients (47.93%) received chemoprophylaxis. The incidence between patients who received and did not receive prophylaxis found no statistically significant difference (p = 0.133). Only one event was found in a severely immunocompromised patient who did not receive the prophylaxis. The absolute risk reduction of primary PCP incidence, and rate of ADRs was 0.89% (95% confidence interval, −0.84, 2.61) and 10.58% in patients who received the chemoprophylaxis, respectively. Conclusion: The initiation of HAART in HIV-infected patients who had the initial CD4+ cell count <200 cells/mm3 may impact on reducing the risk of developing primary PCP. Aside from the patients who received the prophylaxis, most of the adverse reactions were skin disorders.