Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat Asia HIV observational database

Lim, P.L. and Zhou, J.L. and Ditangco, R.A. and Law, M.G. and Sirisanthana, T. and Kumarasamy, N. and Chen, Y.M.A. and Phanuphak, P. and Lee, C.K.C. and Saphonn, V. and Oka, S. and Zhang, F.J. and Choi, J.Y. and Pujari, S. and Kamarulzaman, Adeeba and Li, P.C.K. and Merati, T.P. and Yunihastuti, E. and Messerschmidt, L. and Sungkanuparph, S. (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). ISSN 1758-2652

Full text not available from this repository. (Request a copy)

Abstract

Background: Pneumocystis jiroveci pneumonia (PCP) prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm(3). 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/mm(3), 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.

Item Type: Article
Additional Information: Lim, Poh-Lian Zhou, Jialun Ditangco, Rossana A. Law, Matthew G. Sirisanthana, Thira Kumarasamy, Nagalingeswaran Chen, Yi-Ming A. Phanuphak, Praphan Lee, Christopher K. C. Saphonn, Vonthanak Oka, Shinichi Zhang, Fujie Choi, Jun Y. Pujari, Sanjay Kamarulzaman, Adeeba Li, Patrick C. K. Merati, Tuti P. Yunihastuti, Evy Messerschmidt, Liesl Sungkanuparph, Somnuek
Uncontrolled Keywords: HIV
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms azrahani halim
Date Deposited: 25 Jan 2013 01:25
Last Modified: 21 Mar 2019 04:53
URI: http://eprints.um.edu.my/id/eprint/4578

Actions (login required)

View Item View Item