The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients
Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm 3 or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considere...
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doaj-69896068b03a4c1e9795eaa4f10934772020-11-25T03:22:13ZengSAGE PublishingJournal of the International Association of Providers of AIDS Care2325-95822018-03-011710.1177/2325958218759199The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected PatientsHenry Anyimadu MD0Chandra Pingili MD1Vel Sivapalan MD2Yael Hirsch-Moverman PhD3Sharon Mannheimer MD4 Hospital of Central Connecticut, New Britain, CT, USA Columbia University Affiliated with Harlem Hospital Center, New York, NY, USA Columbia University Affiliated with Harlem Hospital Center, New York, NY, USA Columbia University, New York, NY, USA Columbia University Affiliated with Harlem Hospital Center, New York, NY, USACurrent guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm 3 or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considered for prophylaxis. Discordance between CD4 count and CD4% occurs in 16% to 25% of HIV-infected patients. Provider compliance with current PJP prophylaxis guidelines when such discordance is present was assessed. Electronic medical records of 429 HIV-infected individuals who had CD4 count and CD4% measured at our clinic were reviewed. CD4 count and percentage discordance was seen in 57 (13%) of 429. Patients with CD4 count >200 but CD4% <14 were significantly less likely to be prescribed PJP prophylaxis compared with those who had CD4 count <200 and CD4% >14 (29% versus 86%; odds ratio = 0.064, 95% confidence interval: 0.0168-0.2436; P < .0001). We emphasize monitoring both the absolute CD4 count and percentage to appropriately guide PJP primary and secondary prophylaxis.https://doi.org/10.1177/2325958218759199 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Henry Anyimadu MD Chandra Pingili MD Vel Sivapalan MD Yael Hirsch-Moverman PhD Sharon Mannheimer MD |
spellingShingle |
Henry Anyimadu MD Chandra Pingili MD Vel Sivapalan MD Yael Hirsch-Moverman PhD Sharon Mannheimer MD The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients Journal of the International Association of Providers of AIDS Care |
author_facet |
Henry Anyimadu MD Chandra Pingili MD Vel Sivapalan MD Yael Hirsch-Moverman PhD Sharon Mannheimer MD |
author_sort |
Henry Anyimadu MD |
title |
The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients |
title_short |
The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients |
title_full |
The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients |
title_fullStr |
The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients |
title_full_unstemmed |
The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients |
title_sort |
impact of absolute cd4 count and percentage discordance on pneumocystis jirovecii pneumonia prophylaxis in hiv-infected patients |
publisher |
SAGE Publishing |
series |
Journal of the International Association of Providers of AIDS Care |
issn |
2325-9582 |
publishDate |
2018-03-01 |
description |
Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm 3 or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considered for prophylaxis. Discordance between CD4 count and CD4% occurs in 16% to 25% of HIV-infected patients. Provider compliance with current PJP prophylaxis guidelines when such discordance is present was assessed. Electronic medical records of 429 HIV-infected individuals who had CD4 count and CD4% measured at our clinic were reviewed. CD4 count and percentage discordance was seen in 57 (13%) of 429. Patients with CD4 count >200 but CD4% <14 were significantly less likely to be prescribed PJP prophylaxis compared with those who had CD4 count <200 and CD4% >14 (29% versus 86%; odds ratio = 0.064, 95% confidence interval: 0.0168-0.2436; P < .0001). We emphasize monitoring both the absolute CD4 count and percentage to appropriately guide PJP primary and secondary prophylaxis. |
url |
https://doi.org/10.1177/2325958218759199 |
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