Reasons for Lack of Appropriate Receipt of Primary Pneumocystis jiroveci Pneumonia Prophylaxis among HIV-Infected Persons Receiving Treatment in the United States: 1994-2003

Despite widespread availability of effective prophylaxis, Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) continues to cause substantial morbidity among HIV-infected persons [1,2,3–4]. The US Healthy People 2010 goal is for 95% of eligible persons to receive prophylaxis to prevent the occurrence of PCP [5]. Guidelines for PCP prophylaxis have evolved with advancements in treatment [6]. Since 1995, recommendations from the US Public Health Service and Infectious Diseases Society of America for HIV-infected persons include chemoprophylaxis against primary PCP for persons with a CD4 cell count <200 cells/µL or a history of oral candidiasis [7]. PCP prophylaxis can be discontinued after immune reconstitution associated with antiretroviral therapy (ART) [8,9,10–11]. Current guidelines recommend discontinuation of prophylaxis when a patient's CD4 cell count has been maintained at ⩾200 cells/µL for ⩾3 months in response to ART and reinstitution of prophylaxis if the patient's CD4 cell count decreases to <200 cells/µL [12]. We analyzed data from HIV-infected persons to determine the proportion of eligible persons receiving primary PCP prophylaxis and characteristics of persons not receiving prophylaxis.