{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T04:40:06Z","timestamp":1771562406835,"version":"3.50.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"EuroCoord","award":["260694"],"award-info":[{"award-number":["260694"]}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","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":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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 (\u2264400 copies\/mL), irrespective of CD4 count.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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 \u2264200 cells\/\u00b5L in line with existing recommendations. We compared the following 2 strategies for stopping prophylaxis: (1) when CD4 count was &amp;gt;200 cells\/\u00b5L for &amp;gt;3 months or (2) when the patient was virologically suppressed (2 consecutive HIV RNA\u2005\u2264400 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 4813 patients (10\u2005324 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\u20131.1; P\u2005=\u2005.2).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study suggests that primary PcP prophylaxis might be safely withheld in confirmed virologically suppressed patients on ART, regardless of their CD4 count.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa615","type":"journal-article","created":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T12:32:15Z","timestamp":1589891535000},"page":"195-202","source":"Crossref","is-referenced-by-count":16,"title":["Withholding Primary Pneumocystis Pneumonia Prophylaxis in Virologically Suppressed Patients With Human Immunodeficiency Virus: An Emulation of a Pragmatic Trial in COHERE"],"prefix":"10.1093","volume":"73","author":[{"given":"Andrew","family":"Atkinson","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland"},{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel","family":"Zwahlen","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Barger","sequence":"additional","affiliation":[{"name":"University of Bordeaux, ISPED, Inserm Bordeaux Population Health, Team MORPH3EUS, UMR 1219, Bordeaux, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"d\u2019Arminio Monforte","sequence":"additional","affiliation":[{"name":"Institute of Infectious Diseases, Department of Health Sciences, University of Milan, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephane","family":"De Wit","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Saint Pierre University Hospital, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jade","family":"Ghosn","sequence":"additional","affiliation":[{"name":"APHP, Nord-Universit\u00e9 de Paris, Service des Maladies Infectieuses et Tropicales, H\u00f4pital Bichat, Paris, France"},{"name":"INSERM UMR 1137 IAME, Universit\u00e9 de Paris, Facult\u00e9 de M\u00e9decine, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Girardi","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, National Institute for Infectious Diseases L. 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