Is PCP Prophylaxis Slipping by the Wayside?

In the days before effective antiretrovirals, Pneumocystis jiroveci pneumonia (PCP) prophylaxis was the single most effective therapeutic intervention available to HIV clinicians. Now, this important component of care seems increasingly to be forgotten.

To evaluate patterns in the administration of PCP prophylaxis, researchers analyzed data from 17,452 HIV-infected patients who were eligible for primary prophylaxis between 1990 and 2003. Overall, the proportion of patients who did not receive prophylaxis rose from 16% in 1994 to 24% in 2003. Much of this increase was due to the growing number of people who stopped prophylaxis when CD4 counts rose above 200 cells/mm³ and never resumed it when counts subsequently fell again. By 2003, this cate…