Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: results from the Treat Asia HIV observational database.
Lim, Poh-Lian;
Zhou, Jialun;
Ditangco, Rossana A;
Law, Matthew G;
Sirisanthana, Thira;
Kumarasamy, Nagalingeswaran;
Chen, Yi-Ming A;
Phanuphak, Praphan;
Lee, Christopher KC;
Saphonn, Vonthanak;
+11 more...Oka, Shinichi;
Zhang, Fujie;
Choi, Jun Y;
Pujari, Sanjay;
Kamarulzaman, Adeeba;
Li, Patrick CK;
Merati, Tuti P;
Yunihastuti, Evy;
Messerschmidt, Liesl;
Sungkanuparph, Somnuek;
TREAT Asia HIV Observational Database;
(2012)
Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: results from the Treat Asia HIV observational database.
Journal of the International AIDS Society, 15 (1).
1-.
ISSN 1758-2652
DOI: https://doi.org/10.1186/1758-2652-15-1
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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.
Filename: Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: results from the Treat Asia HIV observational database.pdf