The latest analysis of the incidence of Pneumocystis carinii pneumonia (PCP) in EuroSIDA, Europe’s 7,000 strong cohort of people with HIV infection, continues to show that primary prophylaxis for PCP can be safely discontinued once treatment with HAART has sustained a rise in CD4 count above 200 cells. New data from EuroSIDA was presented yesterday in Lisbon, Portugal, at a special symposium convened to mark the opening of the 7th European Conference on Clinical Aspects and Treatment of HIV Infection.
Peter Weiss reported on 562 HAART recipients who had stopped preventative treatment for PCP a median of nineteen months after starting HAART. Of these, 483 were taking primary prophylaxis, never having had a bout of PCP, whilst the remaining 79 were taking maintenance therapy following an episode of PCP (secondary prophylaxis).
The median nadir CD4 count in the primary prophylaxis group was 123 cells, and prophylaxis was stopped at a median count of 302 cells. Just a single case of PCP has been detected in this group.
Whilst these data support the discontinuation of primary prophylaxis once HAART has restored CD4 count above 200 cells, Weiss concluded that the same could not yet be said of secondary prophylaxis, given the small numbers of patients in that group.
Stefano Vella, of the Istituto Superiore di Sanita, Rome, reported on an initiative to monitor the frequency of ‘new’ adverse events in the EuroSIDA cohort. Investigators have collected data on the incidence of myocardial infarction (MI), insulin dependent diabetes mellitus (IDDM) and hepatic encephalopathy (HE) at two recent patient visits in late 1998 and February of this year.
From 4,247 patient years of follow-up, 14 cases of MI have been detected, 24 cases of IDDM and 11 cases of HE. Comparing relative frequency in PI and non-PI recipients, there were no significant differences for each adverse event. However, there was a trend for both MI and IDDM to occur more frequently in PI recipients, and for HE in non-PI recipients.