{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T23:09:13Z","timestamp":1772752153625,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,6,12]],"date-time":"2021-06-12T00:00:00Z","timestamp":1623456000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["324730_149792"],"award-info":[{"award-number":["324730_149792"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Since the beginning of the HIV epidemic in resource\u2010rich countries, <jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia (PjP) is one of the most frequent opportunistic AIDS\u2010defining infections. The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) has shown that primary <jats:italic>Pneumocystis jirovecii<\/jats:italic> Pneumonia (PjP) prophylaxis can be safely withdrawn in patients with CD4 counts of 100 to 200\u00a0cells\/\u00b5L if plasma HIV\u2010RNA is suppressed on combination antiretroviral therapy. Whether this holds true for secondary prophylaxis is not known, and this has proved difficult to determine due to the much lower population at risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We estimated the incidence of secondary PjP by including patient data collected from 1998 to 2015 from the COHERE cohort collaboration according to time\u2010updated CD4 counts, HIV\u2010RNA and use of PjP prophylaxis in persons &gt;16\u00a0years of age. We fitted a Poisson generalized additive model in which the smoothed effect of CD4 was modelled by a restricted cubic spline, and HIV\u2010RNA was stratified as low (&lt;400), medium (400 to 10,000) or high (&gt;10,000copies\/mL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 373 recurrences of PjP during 74,295 person\u2010years (py) in 10,476 patients. The PjP incidence in the different plasma HIV\u2010RNA strata differed significantly and was lowest in the low stratum. For patients off prophylaxis with CD4 counts between 100 and 200\u00a0cells\/\u00b5L and HIV\u2010RNA below 400\u00a0copies\/mL, the incidence of recurrent PjP was 3.9 (95% CI: 2.0 to 5.8) per 1000 py, not significantly different from patients on prophylaxis in the same stratum (1.9, 95% CI: 0.1 to 3.7).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HIV viraemia importantly affects the risk of recurrent PjP. In virologically suppressed patients on ART with CD4 counts of 100 to 200\/\u00b5L, the incidence of PjP off prophylaxis is below 10\/1000 py. Secondary PjP prophylaxis may be safely withheld in such patients. While European guidelines recommend discontinuing secondary PjP prophylaxis only if CD4 counts rise above 200\u00a0cells\/mL, the latest US Guidelines consider secondary prophylaxis discontinuation even in patients with a CD4 count above 100\u00a0cells\/\u00b5L and suppressed viral load. Our results strengthen and support this US recommendation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25726","type":"journal-article","created":{"date-parts":[[2021,6,12]],"date-time":"2021-06-12T13:10:54Z","timestamp":1623503454000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["No need for secondary <i>Pneumocystis jirovecii<\/i> pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100\u00a0cells\/\u00b5L"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5834-8315","authenticated-orcid":false,"given":"Andrew","family":"Atkinson","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Bern University Hospital Inselspital University of Bern Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose M.","family":"Miro","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service Hospital Clinic \u2013 IDIBAPS University of Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Mocroft","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research Epidemiology, Modelling and Evaluation (CREME) Institute for Global Health UCL London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Reiss","sequence":"additional","affiliation":[{"name":"Department of Global Health Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Global Health and Development, and HIV Monitoring Foundation Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ole","family":"Kirk","sequence":"additional","affiliation":[{"name":"CHIP Department of Infectious Diseases, Rigshospitalet University of Copenhagen Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Morlat","sequence":"additional","affiliation":[{"name":"Internal Medicine and Infectious Diseases Department University Hospital of Bordeaux Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jade","family":"Ghosn","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales Groupe Hospitalier Universitaire Bichat\u2010Claude Bernard Paris France"},{"name":"INSERM U 1137 IAME Universit\u00e9 de Paris Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Stephan","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit at Medical Center no.2 Frankfurt University Hospital Goethe University Frankfurt Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Mussini","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases University of Modena and Reggio Emilia Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia","family":"Antoniadou","sequence":"additional","affiliation":[{"name":"Fourth Department of Internal Medicine ATTIKON University Hospital National and Kapodistrian University of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katja","family":"Doerholt","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases Unit St. George\u2019s University Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8182-5896","authenticated-orcid":false,"given":"Enrico","family":"Girardi","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit National Institute for Infectious Diseases L. 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