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Guidelines for prophylaxis of Pneumocystis pneumonia cannot rely solely on CD4-cell count in autoimmune and inflammatory diseases

1, 2, 3, 4, 5, 6

  1. Department of Clinical Immunology,Saint-André Hospital, CHU de Bordeaux, France. gildas.baulier@chu-bordeaux.fr
  2. Department of Infectious Diseases, Saint-André Hospital, CHU de Bordeaux, France.
  3. Department of Mycology and Parasitology, Pellegrin Hospital, CHU de Bordeaux, France.
  4. Department of Mycology and Parasitology, Pellegrin Hospital, CHU de Bordeaux, France.
  5. Intensive Care Unit, Saint-André Hospital, CHU de Bordeaux, France.
  6. Department of Clinical Immunology,Saint-André Hospital, CHU de Bordeaux, France.

CER10722 Submission on line
2018 Vol.36, N°3 - PI 0490, PF 0493
Brief Papers

Rheumatology Article
Rheumatology Article

 

Abstract

OBJECTIVES:
Guidelines for preventing Pneumocystis pneumonia (PCP) in HIV patients are based on CD4 below 200/mm3. Such cut-off value is suggested to guide prophylaxis in non-HIV conditions (NHIV) especially in autoimmune and inflammatory diseases (AD). We aimed to determine if CD4 could be used to guide PCP prophylaxis in AD.
METHODS:
CD4 and lymphocyte-count were retrospectively studied in patients diagnosed with PCP between January 2013 and February 2016.
RESULTS:
129 patients were included. The median CD4-count was 302/mm3 in AD, which was significantly higher than in HIV patients (19/mm3; p<0.0001). Fifty percent (n=10) of AD patients had CD4 counts greater than 300/mm3.
CONCLUSIONS:
Prophylaxis for PCP cannot rely solely on CD4-count in NHIV patients especially in AD.

PMID: 29533748 [PubMed]

Received: 29/07/2017 - Accepted : 04/12/2017 - In Press: 26/02/2018 - Published: 17/05/2018