Sidhu Vaninder K, Foisy Michelle M, Hughes Christine A
Alberta Health Services, Edmonton, Alberta, Canada.
Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Ann Pharmacother. 2015 Dec;49(12):1343-8. doi: 10.1177/1060028015605113. Epub 2015 Sep 10.
To review the evidence for discontinuing primary and secondary Pneumocystis jirovecii pneumonia (PJP) prophylaxis in HIV-infected patients with a CD4 count <200 cells/mm(3).
We conducted a literature search in MEDLINE, EMBASE, Cochrane Library, Google Scholar, and the International Aids Society Library (up to August 2015) using the following key search terms: Pneumocystis jirovecii, pneumonia, human immunodeficiency virus, primary prophylaxis, secondary prophylaxis, and discontinuation.
All English-language studies that evaluated discontinuation of primary and/or secondary PJP prophylaxis in HIV-infected patients with CD4 count <200 cells/mm(3) were included.
Five studies were identified, which varied in design, sample size, outcomes, and duration of follow-up. Three studies examined discontinuation of primary and secondary PJP prophylaxis; 1 study evaluated discontinuing primary PJP prophylaxis; and 1 study evaluated stopping secondary PJP prophylaxis. Two out of the 5 studies pooled data for all opportunistic infections. Overall, there was a low incidence of PJP among HIV-infected patients who discontinued primary PJP prophylaxis and were well controlled on antiretroviral therapy (ART).
Discontinuation of primary PJP prophylaxis appears to be safe in patients on combination ART with a suppressed HIV viral load and a CD4 count >100 cells/mm(3). Additional data are needed to support the safety of discontinuing secondary PJP prophylaxis. Decisions to discontinue PJP prophylaxis in patients with a CD4 count <200 cells/mm(3) should be done on an individual patient basis, taking into consideration clinical factors, including ongoing adherence to ART.
回顾针对CD4细胞计数<200个/mm³的HIV感染患者停用原发性和继发性耶氏肺孢子菌肺炎（PJP）预防措施的证据。
我们在MEDLINE、EMBASE、Cochrane图书馆、谷歌学术和国际艾滋病协会图书馆（截至2015年8月）进行了文献检索，使用了以下关键检索词：耶氏肺孢子菌、肺炎、人类免疫缺陷病毒、原发性预防、继发性预防和停用。
纳入所有评估CD4细胞计数<200个/mm³的HIV感染患者停用原发性和/或继发性PJP预防措施的英文研究。
共识别出5项研究，这些研究在设计、样本量、结局和随访持续时间方面存在差异。3项研究考察了原发性和继发性PJP预防措施的停用情况；1项研究评估了停用原发性PJP预防措施；1项研究评估了停用继发性PJP预防措施。5项研究中的2项汇总了所有机会性感染的数据。总体而言，在停用原发性PJP预防措施且接受抗逆转录病毒治疗（ART）控制良好的HIV感染患者中，PJP的发病率较低。
对于接受联合ART且HIV病毒载量得到抑制、CD4细胞计数>100个/mm³的患者，停用原发性PJP预防措施似乎是安全的。需要更多数据来支持停用继发性PJP预防措施的安全性。对于CD4细胞计数<200个/mm³的患者，停用PJP预防措施的决定应基于个体患者情况，同时考虑包括持续坚持ART在内的临床因素。
