The role of CD4 cell count as discriminatory measure to guide chemoprophylaxis against Pneumocystis jirovecii pneumonia in human immunodeficiency virus-negative immunocompromised patients: A systematic review.

Autor: Messiaen PE; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.; Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium., Cuyx S; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium., Dejagere T; Department of Nephrology, Jessa Hospital, Hasselt, Belgium., van der Hilst JC; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.; Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2017 Apr; Vol. 19 (2). Date of Electronic Publication: 2017 Feb 15.
DOI: 10.1111/tid.12651
Abstrakt: Background: In recent years, the incidence of Pneumocystis jirovecii pneumonia (PJP) has increased in immunocompromised patients without human immunodeficiency virus (HIV) infection. Chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is highly effective in preventing PJP in both HIV-positive and -seronegative patients. In HIV-positive patients, the risk of PJP is strongly correlated with decreased CD4 cell count. The role of CD4 cell count in the pathogenesis of PJP in non-HIV immunocompromised patients is less well studied. For most immunosuppressive conditions, no clear guidelines indicate whether to start TMP-SMX.
Method: We conducted a systematic literature review with the aim to provide a comprehensive overview on the role of CD4 cell counts in managing the risk of PJP in HIV-seronegative patients.
Results: Of the 63 individual studies retrieved, 14 studies report on CD4 cell counts in a variety of immunosuppressive conditions. CD4 cell count were <200/μL in 73.1% of the patients.
Conclusion: CD4 cell count <200/μL is a sensitive biomarker to identify non-HIV immunocompromised patients who are at risk for PJP. Measuring CD4 cell counts could help clinicians identify patients who may benefit from TMP-SMX prophylaxis.
(© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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