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

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....

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Main Authors: Lim, P.L., Zhou, J.L., Ditangco, R.A., Law, M.G., Sirisanthana, T., Kumarasamy, N., Chen, Y.M.A., Phanuphak, P., Lee, C.K.C., Saphonn, V., Oka, S., Zhang, F.J., Choi, J.Y., Pujari, S., Kamarulzaman, Adeeba, Li, P.C.K., Merati, T.P., Yunihastuti, E., Messerschmidt, L., Sungkanuparph, S.
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Published: Wiley Open Access 2012
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spelling my.um.eprints.45782019-03-21T04:53:06Z http://eprints.um.edu.my/4578/ 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. Zhou, J.L. Ditangco, R.A. Law, M.G. Sirisanthana, T. Kumarasamy, N. Chen, Y.M.A. Phanuphak, P. Lee, C.K.C. Saphonn, V. Oka, S. Zhang, F.J. Choi, J.Y. Pujari, S. Kamarulzaman, Adeeba Li, P.C.K. Merati, T.P. Yunihastuti, E. Messerschmidt, L. Sungkanuparph, S. R Medicine 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. Wiley Open Access 2012 Article PeerReviewed 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
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
spellingShingle R Medicine
Lim, P.L.
Zhou, J.L.
Ditangco, R.A.
Law, M.G.
Sirisanthana, T.
Kumarasamy, N.
Chen, Y.M.A.
Phanuphak, P.
Lee, C.K.C.
Saphonn, V.
Oka, S.
Zhang, F.J.
Choi, J.Y.
Pujari, S.
Kamarulzaman, Adeeba
Li, P.C.K.
Merati, T.P.
Yunihastuti, E.
Messerschmidt, L.
Sungkanuparph, S.
Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat Asia HIV observational database
description 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.
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author Lim, P.L.
Zhou, J.L.
Ditangco, R.A.
Law, M.G.
Sirisanthana, T.
Kumarasamy, N.
Chen, Y.M.A.
Phanuphak, P.
Lee, C.K.C.
Saphonn, V.
Oka, S.
Zhang, F.J.
Choi, J.Y.
Pujari, S.
Kamarulzaman, Adeeba
Li, P.C.K.
Merati, T.P.
Yunihastuti, E.
Messerschmidt, L.
Sungkanuparph, S.
author_facet Lim, P.L.
Zhou, J.L.
Ditangco, R.A.
Law, M.G.
Sirisanthana, T.
Kumarasamy, N.
Chen, Y.M.A.
Phanuphak, P.
Lee, C.K.C.
Saphonn, V.
Oka, S.
Zhang, F.J.
Choi, J.Y.
Pujari, S.
Kamarulzaman, Adeeba
Li, P.C.K.
Merati, T.P.
Yunihastuti, E.
Messerschmidt, L.
Sungkanuparph, S.
author_sort Lim, P.L.
title Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat Asia HIV observational database
title_short Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat Asia HIV observational database
title_full Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat Asia HIV observational database
title_fullStr Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat Asia HIV observational database
title_full_unstemmed Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat Asia HIV observational database
title_sort failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cart era: results from the treat asia hiv observational database
publisher Wiley Open Access
publishDate 2012
url http://eprints.um.edu.my/4578/
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score 13.211869