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What Doctors Don't Tell You © (Volume 11, Issue 12)
Drugs taken to prevent Pneumocystis carinii pneumonia (PCP) can safely be stopped in HIV patients who develop an immunological response following highly active antiretroviral therapy (HAART), according to two studies

In the first, Spanish researchers randomised 587 HIV patients receiving PCP prophylaxis to either continue or discontinue treatment.

Of 474 patients receiving primary prophylaxis, 240 patients discontinued and experienced no PCP episodes after a median follow up period of 20 months. Of 113 patients receiving drugs to prevent a second infection, 60 patients stopped and had no PCP episodes after a median follow up period of 12 months.

In a second study, Swiss researchers assessed the incidence of recurrent PCP in 325 HIV patients who stopped secondary prophylaxis after achieving a CD4 cell count of more than 200 cells/mL while receiving at least three antiretroviral drugs. As with the Spanish results, the Swiss team found no cases of recurrence of PCP at a median of 13 months after discontinuation of the drugs.

These results suggest that if the response to antiretroviral therapy is good, just in case preventative drugs can be discontinued even in patients who have had previous P. carinii pneumonia (N Engl J Med, 2001; 344: 159-67, 168-73).

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