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

dc.rights.licenseopenen_US
dc.contributor.authorATKINSON, Andrew
dc.contributor.authorZWAHLEN, Marcel
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBARGER, Diana
dc.contributor.authorD'ARMINIO MONFORTE, Antonella
dc.contributor.authorDE WIT, Stephane
dc.contributor.authorGHOSN, Jade
dc.contributor.authorGIRARDI, Enrico
dc.contributor.authorSVEDHEM, Veronica
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorMORLAT, Philippe
dc.contributor.authorMUSSINI, Cristina
dc.contributor.authorNOGUERA-JULIAN, Antoni
dc.contributor.authorSTEPHAN, Christoph
dc.contributor.authorTOULOUMI, Giota
dc.contributor.authorKIRK, Ole
dc.contributor.authorMOCROFT, Amanda
dc.contributor.authorREISS, Peter
dc.contributor.authorMIRO, Jose M.
dc.contributor.authorCARPENTER, James R.
dc.contributor.authorFURRER, Hansjakob
dc.date.accessioned2021-09-29T09:20:44Z
dc.date.available2021-09-29T09:20:44Z
dc.date.issued2021-07-15
dc.identifier.issn1058-4838en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/112474
dc.description.abstractEnBACKGROUND: 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.
dc.language.isoENen_US
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subject.enHuman immunodeficiency virus
dc.subject.enPneumocystis pneumonia
dc.subject.enProphylaxis
dc.subject.enHIV-RNA
dc.title.enWithholding Primary Pneumocystis Pneumonia Prophylaxis in Virologically Suppressed Patients With Human Immunodeficiency Virus: An Emulation of a Pragmatic Trial in COHERE
dc.typeArticle de revueen_US
dc.identifier.doi10.1093/cid/ciaa615en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed32448894en_US
dc.description.sponsorshipEuropeEuropean Network of HIV/AIDS Cohort Studies to Coordinate at European and International Level Clinical Research on HIV/AIDSen_US
bordeaux.journalClinical Infectious Diseasesen_US
bordeaux.page195-202en_US
bordeaux.volume73en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue2en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamCOHEREen_US
bordeaux.teamMORPH3Eusen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDAgence Nationale de Recherches sur le Sida et les Hépatites Viralesen_US
hal.identifierhal-03358181
hal.version1
hal.date.transferred2021-09-29T09:20:51Z
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Clinical%20Infectious%20Diseases&rft.date=2021-07-15&rft.volume=73&rft.issue=2&rft.spage=195-202&rft.epage=195-202&rft.eissn=1058-4838&rft.issn=1058-4838&rft.au=ATKINSON,%20Andrew&ZWAHLEN,%20Marcel&BARGER,%20Diana&D'ARMINIO%20MONFORTE,%20Antonella&DE%20WIT,%20Stephane&rft.genre=article


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