Withholding Primary Pneumocystis Pneumonia Prophylaxis in Virologically Suppressed Patients With Human Immunodeficiency Virus: An Emulation of a Pragmatic Trial in COHERE

Autor: Atkinson A., Zwahlen M., Barger D., D'arminio Monforte A., De Wit S., Ghosn J., Girardi E., Svedhem V., Morlat P., Mussini C., Noguera-Julian A., Stephan C., Touloumi G., Kirk O., Mocroft A., Reiss P., Miro J. M., Carpenter J. R., Furrer H., Judd A., Zangerle R., Warszawski J., Meyer L., Dabis F., Krause M. M., Leport C., Wittkop L., Wit F., Prins M., Bucher H., Gibb D., Fatkenheuer G., Del Amo J., Obel N., Thorne C., Perez-Hoyos S., Hamouda O., Bartmeyer B., Chkhartishvili N., Antinori A., Brockmeyer N., Prieto L., Rojo Conejo P., Soriano-Arandes A., Battegay M., Kouyos R., Casabona J., M. Miro J., Castagna A., Konopnick D., Goetghebuer T., Sonnerborg A., Torti C., Sabin C., Teira R., Garrido M., Haerry D., Costagliola D., D'arminio-Monforte A., Raben D., Chene G.
Přispěvatelé: Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de Recherches sur le Sida et les Hépatites Virales, European Project: 260694,EC:FP7:HEALTH,FP7-HEALTH-2010-single-stage,EUROCOORD(2011), Atkinson, A., Zwahlen, M., Barger, D., D'arminio Monforte, A., De Wit, S., Ghosn, J., Girardi, E., Svedhem, V., Morlat, P., Mussini, C., Noguera-Julian, A., Stephan, C., Touloumi, G., Kirk, O., Mocroft, A., Reiss, P., Miro, J. M., Carpenter, J. R., Furrer, H., Judd, A., Zangerle, R., Warszawski, J., Meyer, L., Dabis, F., Krause, M. M., Leport, C., Wittkop, L., Wit, F., Prins, M., Bucher, H., Gibb, D., Fatkenheuer, G., Del Amo, J., Obel, N., Thorne, C., Perez-Hoyos, S., Hamouda, O., Bartmeyer, B., Chkhartishvili, N., Antinori, A., Brockmeyer, N., Prieto, L., Rojo Conejo, P., Soriano-Arandes, A., Battegay, M., Kouyos, R., Casabona, J., M. Miro, J., Castagna, A., Konopnick, D., Goetghebuer, T., Sonnerborg, A., Torti, C., Sabin, C., Teira, R., Garrido, M., Haerry, D., Costagliola, D., D'arminio-Monforte, A., Raben, D., Chene, G., Global Health, Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life
Rok vydání: 2020
Předmět:
Microbiology (medical)
Microbiologie et protistologie [parasitologie hum. et anim.]
medicine.medical_specialty
Human immunodeficiency virus (HIV)
HIV Infections
Logistic regression
Pneumocystis pneumonia
medicine.disease_cause
01 natural sciences
law.invention
010104 statistics & probability
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
Pragmatic Clinical Trials as Topic
medicine
Humans
030212 general & internal medicine
0101 mathematics
Pathologie maladies infectieuses
AIDS-Related Opportunistic Infections
human immunodeficiency virus
business.industry
Pneumonia
Pneumocystis
pneumocystis pneumonia
Hazard ratio
HIV
medicine.disease
Confidence interval
3. Good health
CD4 Lymphocyte Count
Microbiologie et protistologie [entomologie
phytoparasitolog.]
Major Articles and Commentaries
Infectious Diseases
AcademicSubjects/MED00290
HIV-RNA
Censoring (clinical trials)
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Observational study
prophylaxis
business
Microbiologie et protistologie [bacteriol.virolog.mycolog.]
Zdroj: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Clinical infectious diseases :an official publication of the Infectious Diseases Society of America, 73 (2
the Opportunistic Infections Project Working Group of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord 2021, ' Withholding Primary Pneumocystis Pneumonia Prophylaxis in Virologically Suppressed Patients With Human Immunodeficiency Virus : An Emulation of a Pragmatic Trial in COHERE ', Clinical Infectious Diseases, vol. 73, no. 2, pp. 195-202 . https://doi.org/10.1093/cid/ciaa615
Clinical Infectious Diseases
Clinical Infectious Diseases, Oxford University Press (OUP), 2021, 73 (2), pp.195-202. ⟨10.1093/cid/ciaa615⟩
Clinical infectious diseases, 73(2), 195-202. Oxford University Press
ISSN: 1537-6591
1058-4838
DOI: 10.1093/cid/ciaa615
Popis: BACKGROUND: Using data from the COHERE collaboration, we investigated whether primary prophylaxis for pneumocystis pneumonia (PcP) might be withheld in all patients on antiretroviral therapy (ART) with suppressed plasma human immunodeficiency virus (HIV) RNA (≤400 copies/mL), irrespective of CD4 count. METHODS: We implemented an established causal inference approach whereby observational data are used to emulate a randomized trial. Patients taking PcP prophylaxis were eligible for the emulated trial if their CD4 count was ≤200 cells/µL in line with existing recommendations. We compared the following 2 strategies for stopping prophylaxis: (1) when CD4 count was >200 cells/µL for >3 months or (2) when the patient was virologically suppressed (2 consecutive HIV RNA ≤400 copies/mL). Patients were artificially censored if they did not comply with these stopping rules. We estimated the risk of primary PcP in patients on ART, using the hazard ratio (HR) to compare the stopping strategies by fitting a pooled logistic model, including inverse probability weights to adjust for the selection bias introduced by the artificial censoring. RESULTS: A total of 4813 patients (10 324 person-years) complied with eligibility conditions for the emulated trial. With primary PcP diagnosis as an endpoint, the adjusted HR (aHR) indicated a slightly lower, but not statistically significant, different risk for the strategy based on viral suppression alone compared with the existing guidelines (aHR, 8; 95% confidence interval, 6-1.1; P = .2). CONCLUSIONS: This study suggests that primary PcP prophylaxis might be safely withheld in confirmed virologically suppressed patients on ART, regardless of their CD4 count.
SCOPUS: ar.j
info:eu-repo/semantics/published
Databáze: OpenAIRE
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