Risk Factors for PrimaryPneumocystis cariniiPneumonia in Human Immunodeficiency Virus‐Infected Adolescents and Adults in the United States: Reassessment of Indications for Chemoprophylaxis

Abstract

Risk factors for the development of a first episode of Pneumocystis carinii pneumonia (PCP) were investigated in the Adult and Adolescent Spectrum of Disease Project, a medical record review study involving longitudinal follow-up of human immunodeficiency virus—infected adults in 9 US cities. Risk factors included decreasing CD4 lymphocyte count and history of AIDS-defining illness, non—P. carinii pneumonia, oral thrush, or unexplained fever for ≥2 days; PCP prophylaxis was protective. PCP incidence/100 person-years of observation among persons not prescribed PCP prophylaxis was higher in those with CD4 lymphocyte counts <250 cells/µL or CD4 cell percent <14% (8.3; 95% confidence interval [CI], 7.7–9.0) than in persons with CD4 cell counts <200 or history of thrush or fever, which constitute current criteria for prophylaxis against PCP (5.9; 95% CI, 5.5–6.4). Because of increased efficiency in capturing persons at highest risk, CD4 cell count <250 or CD4 cell percent <14% should be considered as criteria for prophylaxis against first episodes of PCP.