Published in:
Open Access
01-12-2012 | Research
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, the TREAT Asia HIV Observational Database
Published in:
Journal of the International AIDS Society
|
Issue 1/2012
Login to get access
Abstract
Background
Pneumocystis jiroveci pneumonia (PCP) prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm3. 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/mm3. 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/mm3, 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/mm3, 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/mm3 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.