Chemoprophylaxis can prevent Pneumocystis carinii pneumonia (PCP) in patients immunocompromised due to HIV infection. This can be discontinued in patients with immune reconstitution following highly active antiretroviral therapy (HAART).


Indications for starting chemoprophylaxis:

(1) CD4 lymphocyte count < 200 per µL

(2) one or more of the following:

(a) history of thrush (oropharyngeal candidiasis)

(b) history of unexplained fever for > 2 weeks

(c) substantial unexplained weight loss

(d) prior AIDS-defining event

(e) prior episode of any type of pneumonia

(f) history of previous PCP (secondary prophylaxis)


Chemoprophylaxis can be discontinued in a patient receiving HAART if:

(1) CD4 > 200 per µL for >= 3 months

(2) CD4 > 300 per µL for first time after starting HAART (Goldie et al, 2002)


Chemoprophylaxis should be restarted if CD4 < 200 per µL.


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