CD4+ Cells and CD4 + Percent as Risk Markers for Pneumocystis carinii Pneumonia (PCP): Implications for Primary PCP Prophylaxis

Abstract

The incidence of Pneumocystis carinii pneumonia (PCP) during 2 years in HIV-infected patients with ≤ 100 × 10⁶/l CD4+ cells, ≤ 200 × 10⁶/l CD4+ cells and ≤ 20% CD4+ cells of total T lymphocytes were compared. The relative PCP risk in 57 patients with ≤ 100 CD4+ cells was more than twice higher than in 120 patients with ≤ 200 CD4+ cells. The latter had almost twice higher relative PCP risk than 271 patients with ≤ 20% CD4+ cells. Only 3/56 patients who acquired PCP had ≤ 200 CD4+ cells and 15/56 patients had ≤ 100 CD4+ cells. Centers for Disease Control (CDC) recommends primary PCP prophylaxis in HIV-infected patients when the number of CD4+ cells is ≤ 200 × 10⁶/l or when the CD4+% is ≤ 20. On the basis of the presented data we suggest that primary prophylaxis is considered only when CD4+ cells fall below 200 × 10⁶l