Andrew Atkinson, Marcel Zwahlen, Diana Barger, Antonella d’Arminio Monforte, Stephane de Wit, Enrico Girardi, Veronica Svedhem, Philippe Morlat, Cristina Mussini, Antoni Noguera-Julian, Christoph Stephan, Giota Touloumi, Ole Kirk, Amanda Mocroft, Peter Reiss, Jose Maria Miró, James R. Carpenter, Hansjakob Furrer
- Background: Using data from the COHERE collaboration, we investigated whether primary prophylaxis for pneumocystis pneumonia (PcP) might be withheld in all patients on antiretroviral therapy (ART) with suppressed plasma human immunodeficiency virus (HIV) RNA (≤400 copies/mL), irrespective of CD4 count.
Methods: We implemented an established causal inference approach whereby observational data are used to emulate a randomized trial. Patients taking PcP prophylaxis were eligible for the emulated trial if their CD4 count was ≤200 cells/µL in line with existing recommendations. We compared the following 2 strategies for stopping prophylaxis: (1) when CD4 count was >200 cells/µL for >3 months or (2) when the patient was virologically suppressed (2 consecutive HIV RNA ≤400 copies/mL). Patients were artificially censored if they did not comply with these stopping rules. We estimated the risk of primary PcP in patients on ART, using the hazard ratio (HR) to compare the stopping strategies by fitting a pooled logistic model, including inverse probability weights to adjust for the selection bias introduced by the artificial censoring.
Results: A total of 4813 patients (10 324 person-years) complied with eligibility conditions for the emulated trial. With primary PcP diagnosis as an endpoint, the adjusted HR (aHR) indicated a slightly lower, but not statistically significant, different risk for the strategy based on viral suppression alone compared with the existing guidelines (aHR, .8; 95% confidence interval, .6–1.1; P = .2).
Conclusions: This study suggests that primary PcP prophylaxis might be safely withheld in confirmed virologically suppressed patients on ART, regardless of their CD4 count.
MetadatenAuthor: | Andrew AtkinsonGND, Marcel ZwahlenORCiDGND, Diana BargerORCiD, Antonella d’Arminio MonforteORCiD, Stephane de Wit, Enrico GirardiORCiD, Veronica Svedhem, Philippe MorlatORCiD, Cristina MussiniORCiD, Antoni Noguera-JulianORCiD, Christoph StephanORCiDGND, Giota Touloumi, Ole KirkORCiD, Amanda MocroftORCiD, Peter ReissORCiD, Jose Maria MiróGND, James R. CarpenterORCiDGND, Hansjakob FurrerORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-629170 |
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DOI: | https://doi.org/10.1093/cid/ciaa615 |
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ISSN: | 1537-6591 |
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Parent Title (English): | Clinical infectious diseases |
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Publisher: | Oxford Journals |
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Place of publication: | Oxford |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2021/07/15 |
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Date of first Publication: | 2021/07/15 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Contributing Corporation: | Opportunistic Infections Project Working Group of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord |
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Release Date: | 2023/06/14 |
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Tag: | HIV-RNA; anti-retroviral agents; blood hiv rna; cd4 count determination procedure; guidelines; hiv; human immunodeficiency virus; pneumocystis carinii; pneumocystis pneumonia; pneumonia; prevention; prophylaxis |
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Volume: | 73 |
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Issue: | 2 |
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Page Number: | 8 |
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First Page: | 195 |
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Last Page: | 202 |
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Note: | The COHERE study group has received unrestricted funding from Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (ANRS), France; HIV Monitoring Foundation, The Netherlands; and the Augustinus Foundation, Denmark. The research leading to these results received funding from the European Union Seventh Framework Program (FP7/2007–2013) under EuroCoord grant agreement number 260694. A list of the funders of the participating cohorts can be found at www.COHERE.org. Research reported in this publication was supported by the Swiss National Science Foundation (grant number 324730_149792, principal investigator: H. F.), specifically for H. F. and A. A. |
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Note: | Data availability
Data used for the analysis will generally not be publicly available but can be made available based on the approval by the chair of the executive committee of COHERE (Stephane De Wit; refer to author list). |
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HeBIS-PPN: | 510031137 |
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Institutes: | Medizin / Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - CC BY-NC-ND - Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International |
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