Anyimadu Henry, Pingili Chandra, Sivapalan Vel, Hirsch-Moverman Yael, Mannheimer Sharon
1 Hospital of Central Connecticut, New Britain, CT, USA.
2 Columbia University Affiliated with Harlem Hospital Center, New York, NY, USA.
J Int Assoc Provid AIDS Care. 2018 Jan-Dec;17:2325958218759199. doi: 10.1177/2325958218759199.
Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considered for prophylaxis. Discordance between CD4 count and CD4% occurs in 16% to 25% of HIV-infected patients. Provider compliance with current PJP prophylaxis guidelines when such discordance is present was assessed. Electronic medical records of 429 HIV-infected individuals who had CD4 count and CD4% measured at our clinic were reviewed. CD4 count and percentage discordance was seen in 57 (13%) of 429. Patients with CD4 count >200 but CD4% <14 were significantly less likely to be prescribed PJP prophylaxis compared with those who had CD4 count <200 and CD4% >14 (29% versus 86%; odds ratio = 0.064, 95% confidence interval: 0.0168-0.2436; P < .0001). We emphasize monitoring both the absolute CD4 count and percentage to appropriately guide PJP primary and secondary prophylaxis.
当前指南建议，HIV感染患者若其CD4细胞计数<200个/立方毫米或患有口咽念珠菌病，应接受针对耶氏肺孢子菌肺炎（PJP）的化学预防。CD4百分比（CD4%）低于14%的患者也应考虑进行预防。16%至25%的HIV感染患者存在CD4细胞计数与CD4%不一致的情况。本研究评估了存在这种不一致情况时医疗服务提供者对当前PJP预防指南的依从性。回顾了在我们诊所测量过CD4细胞计数和CD4%的429例HIV感染个体的电子病历。429例中有57例（13%）出现CD4细胞计数与百分比不一致。与CD4细胞计数<200且CD4%>14的患者相比，CD4细胞计数>200但CD4%<14的患者接受PJP预防治疗的可能性显著降低（29%对86%；优势比=0.064，95%置信区间：0.0168 - 0.2436；P<0.0001）。我们强调同时监测绝对CD4细胞计数和百分比，以适当指导PJP的一级和二级预防。
