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

Clin Exp Rheumatol. 2018 May-Jun;36(3):490-493. Epub 2018 Feb 26.

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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / complications
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / drug therapy
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / immunology
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / immunology
  • Autoimmune Diseases / complications
  • Autoimmune Diseases / drug therapy*
  • Autoimmune Diseases / immunology
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology*
  • Cryoglobulinemia / complications
  • Cryoglobulinemia / drug therapy
  • Cryoglobulinemia / immunology
  • Dermatomyositis / complications
  • Dermatomyositis / drug therapy
  • Dermatomyositis / immunology
  • Disease Management
  • Female
  • Giant Cell Arteritis / complications
  • Giant Cell Arteritis / drug therapy
  • Giant Cell Arteritis / immunology
  • HIV Infections / complications
  • HIV Infections / therapy*
  • Hepatitis, Autoimmune / complications
  • Hepatitis, Autoimmune / drug therapy
  • Hepatitis, Autoimmune / immunology
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects*
  • Lymphopenia / drug therapy*
  • Lymphopenia / etiology
  • Lymphopenia / immunology
  • Male
  • Middle Aged
  • Neoplasms / complications
  • Neoplasms / immunology
  • Neoplasms / therapy
  • Organ Transplantation
  • Pneumonia, Pneumocystis / etiology
  • Pneumonia, Pneumocystis / immunology
  • Pneumonia, Pneumocystis / prevention & control*
  • Practice Guidelines as Topic
  • Retrospective Studies

Substances

  • Immunosuppressive Agents