{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,2]],"date-time":"2025-03-02T16:10:16Z","timestamp":1740931816420,"version":"3.38.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2010,6,1]],"date-time":"2010-06-01T00:00:00Z","timestamp":1275350400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2010,6]]},"abstract":"<jats:p> Pneumocystis jirovecii pneumonia (PCP) prophylaxis may be discontinued when CD4 is \u2265200 cells\/mm<jats:sup>3<\/jats:sup> for three months in response to highly active antiretroviral therapy (HAART). Unlike CD4, the total lymphocyte count (TLC) is inexpensive and widely available in resource-constrained countries. Paired TLC and CD4 values of HIV-infected patients attending an HIV clinic from 1998 to 2005 were analysed by Spearman's correlation. The sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristics (ROC) using TLC cut-off points between \u22651400 and \u22652000 cells\/mm<jats:sup>3<\/jats:sup> to predict CD4 \u2265200 cells\/mm<jats:sup>3<\/jats:sup> were calculated. Next, a cohort of patients who had a TLC \u2264 1200 cells\/mm<jats:sup>3<\/jats:sup> and subsequently achieved various TLC cut-off points sustained over three months while receiving HAART was identified. Subjects with subsequent CD4 \u2265200 cells\/mm<jats:sup>3<\/jats:sup> in response to HAART were considered to have negligible risk for PCP. There was significant correlation between TLC and CD4 in 46,250 observations from 4307 individuals ( r = 0.695, P \u2264 0.001). The area under the ROC curve was 0.85 (95% CI = 0.85\u20130.86). In the historical cohort analysis, 85% and 70% of subjects who achieved TLC \u2265 2000 cells\/mm<jats:sup>3<\/jats:sup> and \u22651400, respectively, had a corresponding CD4 \u2265 200 cells\/mm<jats:sup>3<\/jats:sup>. A sustained rise in TLC in response to HAART may potentially serve as a criterion for discontinuing PCP prophylaxis in resource-constrained countries. <\/jats:p>","DOI":"10.1258\/ijsa.2009.009090","type":"journal-article","created":{"date-parts":[[2010,7,6]],"date-time":"2010-07-06T23:38:49Z","timestamp":1278459529000},"page":"406-409","source":"Crossref","is-referenced-by-count":2,"title":["<i>Pneumocystis jirovecii<\/i> prophylaxis discontinuation based upon total lymphocyte count in HIV-infected adults treated with antiretroviral therapy"],"prefix":"10.1177","volume":"21","author":[{"given":"C","family":"Cheung","sequence":"first","affiliation":[{"name":"St Barnabas Hospital, Albert Einstein College of Medicine, Bronx, NY, USA"},{"name":"Albert Einstein College of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Shuter","sequence":"additional","affiliation":[{"name":"Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2010,6,1]]},"reference":[{"key":"bibr1-ijsa.2009.009090","unstructured":"UNAIDS\/WHO. Aids Epidemic Update, December 2007. See http:\/\/data.unaids.org\/pub\/EPISlides\/2007\/2007_epiupdate_en.pdf (last accessed 26 May 2010)"},{"key":"bibr2-ijsa.2009.009090","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200101183440301"},{"key":"bibr3-ijsa.2009.009090","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199904293401701"},{"key":"bibr4-ijsa.2009.009090","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000176591.06549.de"},{"key":"bibr5-ijsa.2009.009090","unstructured":"Duncombe C, Kerr S, Ungsedhapand C, HIV-NAT Study Group. Immune recovery and stopping cotrimoxazole prophylaxis in Thai patients treated with NNRTI-based HAART for 216 weeks [abstract number 784]. In: 13th Conference of Retroviruses and Opportunistic Infections. Denver, 2006"},{"key":"bibr6-ijsa.2009.009090","unstructured":"World Health Organization. Guidelines on Co-trimoxazole Prophylaxis for HIV-Related Infections among Children, Adolescents and Adults in Resource-Limited Settings. 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