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March 15, 1995

Prophylaxis Against Pneumocystis carinii Pneumonia at Higher CD4+ T-Cell Counts

Author Affiliations

for the Adolescent and Adult HIV Spectrum of Disease Project Group Centers for Disease Control and Prevention Atlanta, Ga

JAMA. 1995;273(11):848. doi:10.1001/jama.1995.03520350030023

To the Editor.  —Current recommendations for the prevention of first episodes of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)—infected adults and adolescents state that prophylaxis should begin when the CD4+ count falls below 0.200 × 109/L (200/μL).1 However, the risk of PCP in patients with CD4+ counts greater than 0.200 × 109/L, although low, is not zero, and some experts on the US Public Health Service Task Force that made the current recommendations felt that prophylaxis could also be considered in patients with higher CD4+ counts.1We have estimated the number of cases of primary PCP that could potentially be prevented if the recommended CD4+ threshold for initiating prophylaxis were raised to 0.300 × 109/L, using data from a large multisite project in which medical records of HIV-infected patients are reviewed at regular intervals.2 Between January 1990 and April

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