Pneumocystis Pneumonia (PCP) prophylaxis is often continued despite acceptable CD4 counts in HIV positive individuals on antiretroviral (ARV) treatment. Both BHIVA and EACS guidelines advise discontinuing prophylaxis if the CD4 count is >200 cells/mm3 for 3 months, EACS additionally states that prophylaxis should be stopped if the patient has a CD4 count of 100-200 and an undetectable Viral Load (VL) for 3 months.Methods
We analysed the case notes of all individuals actively receiving Co-trimoxazole prophylaxis prescriptions, and assessed clinical details, CD4 count and VL data to decide whether their continued prescription was in accordance with current guidelines.Results
We identified 32 patients, 27 male, currently on Co-trimoxazole prophylaxis. 18 individuals (56%) met the criteria for continuing PCP prophylaxis. Of the remaining 14, 3 individuals were on immunosuppressive medications for co-morbidities, and were therefore appropriately receiving prophylaxis. 11 of 32 individuals (34%) were found to be receiving Co-trimoxazole despite meeting guidance for discontinuing prophylaxis. 8 of these patients met the BHIVA guidelines, while an additional 3 met the EACS guidelines.Discussion
Our results suggest a significant number of individuals currently receiving PCP prophylaxis could stop. This would reduce their pill burden and minimise the effects of polypharmacy, as well as reduce cost to the NHS. Clinicians should therefore regularly review the need to continue PCP prophylaxis.