Simple FactSheet: Stopping Prophylaxis

Stopping Prophylaxis for Opportunistic Infections
a Simple FactSheet from the AIDS Treatment Data Network

||||| Why Do You Need Prophylaxis:

Until recently, preventive treatments called prophylaxis have been standard for people at risk for certain opportunistic infections. Studies have shown that treatment with HAART (Highly Active Anti-Retroviral Therapy) combinations can increase CD4 cell counts and improve immune system function. Because it wasn't certain that the increase in CD4 cells meant the immune system could fight off infections like PCP, doctors have been cautious about stopping preventive treatments like Bactrim. Several studies have now suggested that if CD4-cell increases are maintained for 3-6 months, some preventive treatments can safely be stopped. Due to these new study results, several sections of the Public Health Service (PHS) Guidelines on Preventing Opportunistic Infections have been updated.

||||| Stopping prophylaxis for PCP:

The recommendations for starting PCP prophylaxis have not changed: start PCP prophylaxis if the CD4-cell count is less than 200 or there is a history of thrush. A new section has now been added to the guidelines about stopping PCP prophylaxis. This section says that providers may wish to stop PCP prophylaxis when an individual's CD4-cell count has stayed over 200 for at least 3 months. The same applies to people who have had PCP. As for restarting PCP prophylaxis, the guidelines use the same rules as for starting: restart preventive treatment if the CD4-cell count drops below 200 again.

||||| Stopping prophylaxis for Toxoplasmosis:

A new recommendation was added in the 2001 update on the guidelines to discontinue prophylaxis for toxoplasmosis as well. It is the same as stopping PCP prophylaxis: when an individual's CD4-cell count has stayed over 200 for at least 3 months.

For people who have had Toxo infection it's necessary to take treatment to prevent it coming back (this is called maintenance treatment). The 2001 guidelines say stopping Toxo prophylaxis if the CD4-cell count increases to over 200 cells for at least 6 months, if the individual have completed the initial Toxo therapy and have no symptoms of the disease.

||||| Stopping prophylaxis for MAC:

Recommendations for preventing mycobacterium avium complex (MAC) have also changed. MAC used to be a common opportunistic infection in people with low CD4-cell counts. Symptoms of MAC include weight loss, fevers, chills, night sweats, swollen glands, abdominal pains, diarrhea and overall weakness. The risk of developing MAC is highest in people with less than 50 CD4-cells. The PHS Guidelines recommend preventive therapy for MAC if the CD4-cell count gets this low. The recommended drugs are either clarithromycin (Biaxin) or azithromycin (Zithromax).

The updated PHS Guidelines contain new recommendations for stopping MAC prophylaxis. The guidelines say that it is reasonable to consider stopping MAC prophylaxis if the CD4-cell count increases to over 100 cells for at least 3 months. The guidelines recommend restarting MAC preventive treatment if the CD4-cell count drops below 50 again.

For people who have had MAC infection it's necessary to take treatment to prevent it coming back (this is called maintenance treatment). The 2001 guidelines say you can stop MAC prophylaxis if the CD4-cell count increases to over 100 cells for at least 6 months, if the individual have completed 12 months of MAC therapy and have no symptoms of the disease.

||||| Stopping maintenance treatment for CMV:

The other HAART-related change in the PHS Guidelines are for cytomegalovirus (CMV) infection. CMV is a herpes virus that can cause illness, most commonly when the T-cell count is less than 50. CMV can cause retinitis, an eye infection that can lead to loss of vision. Standard treatment for CMV involves drugs given intravenously. Once someone has had CMV, ongoing, or maintenance treatment is needed to prevent the CMV infection from becoming active again. Several studies have now shown that when CD4-cell counts increase to over 100-150 cells, maintenance treatment for CMV may not be as necessary.

The PHS Guidelines are cautious about this information, because active CMV disease can be very serious. The updated guidelines say that stopping maintenance treatment may be considered if there is a sustained CD4-cell increase to over 100-150 cells. Any decision to stop CMV maintenance therapy should be made in consultation with an eye doctor, or ophthalmologist who's familiar with CMV. The ophthalmologist will take a number of factors into account, including how threatening the CMV infection may be to the person's vision.

||||| Stopping maintenance treatment for Cryptococcosis:

For people who have had Cryptococcosis infection it's necessary to take treatment to prevent it coming back (this is called maintenance treatment). The 2001 guidelines say stopping Crypto prophylaxis can be considered if the CD4-cell count increases to over 100-200 cells for at least 6 months, if the individual have completed initial treatment of Crypto therapy and have no symptoms of the disease.

The new PHS Guidelines for the Prevention of Opportunistic Infections can be found on the Internet at: http://www.hivatis.org/trtgdlns.html.

This article appeared in the July 1999 issue of Body Positive, and has been updated to reflect changes in the 2001 OI guidelines by the Network. If you'd like more information about Body Positive's excellent monthly magazine, or their services, call them at (212) 566-7333 or e-mail them at bodypos@aol.com.

Recent Updates • Home • Hepatitis Co-infection • About The Network • The Access Project • Simple Fact Sheets
Last modified: 8/15/2006
copyright © 2006 The Network
Contact The Network

\|\|\|\|\| Why Do You Need Prophylaxis:
Until recently, preventive treatments called prophylaxis have been standard for people at risk for certain opportunistic infections. Studies have shown that treatment with HAART (Highly Active Anti-Retroviral Therapy) combinations can increase CD4 cell counts and improve immune system function. Because it wasn't certain that the increase in CD4 cells meant the immune system could fight off infections like PCP, doctors have been cautious about stopping preventive treatments like Bactrim. Several studies have now suggested that if CD4-cell increases are maintained for 3-6 months, some preventive treatments can safely be stopped. Due to these new study results, several sections of the Public Health Service (PHS) Guidelines on Preventing Opportunistic Infections have been updated.
\|\|\|\|\| Stopping prophylaxis for PCP:
The recommendations for starting PCP prophylaxis have not changed: start PCP prophylaxis if the CD4-cell count is less than 200 or there is a history of thrush. A new section has now been added to the guidelines about stopping PCP prophylaxis. This section says that providers may wish to stop PCP prophylaxis when an individual's CD4-cell count has stayed over 200 for at least 3 months. The same applies to people who have had PCP. As for restarting PCP prophylaxis, the guidelines use the same rules as for starting: restart preventive treatment if the CD4-cell count drops below 200 again.
\|\|\|\|\| Stopping prophylaxis for Toxoplasmosis:
A new recommendation was added in the 2001 update on the guidelines to discontinue prophylaxis for toxoplasmosis as well. It is the same as stopping PCP prophylaxis: when an individual's CD4-cell count has stayed over 200 for at least 3 months. For people who have had Toxo infection it's necessary to take treatment to prevent it coming back (this is called maintenance treatment). The 2001 guidelines say stopping Toxo prophylaxis if the CD4-cell count increases to over 200 cells for at least 6 months, if the individual have completed the initial Toxo therapy and have no symptoms of the disease.
\|\|\|\|\| Stopping prophylaxis for MAC:
Recommendations for preventing mycobacterium avium complex (MAC) have also changed. MAC used to be a common opportunistic infection in people with low CD4-cell counts. Symptoms of MAC include weight loss, fevers, chills, night sweats, swollen glands, abdominal pains, diarrhea and overall weakness. The risk of developing MAC is highest in people with less than 50 CD4-cells. The PHS Guidelines recommend preventive therapy for MAC if the CD4-cell count gets this low. The recommended drugs are either clarithromycin (Biaxin) or azithromycin (Zithromax). The updated PHS Guidelines contain new recommendations for stopping MAC prophylaxis. The guidelines say that it is reasonable to consider stopping MAC prophylaxis if the CD4-cell count increases to over 100 cells for at least 3 months. The guidelines recommend restarting MAC preventive treatment if the CD4-cell count drops below 50 again. For people who have had MAC infection it's necessary to take treatment to prevent it coming back (this is called maintenance treatment). The 2001 guidelines say you can stop MAC prophylaxis if the CD4-cell count increases to over 100 cells for at least 6 months, if the individual have completed 12 months of MAC therapy and have no symptoms of the disease.
\|\|\|\|\| Stopping maintenance treatment for CMV:
The other HAART-related change in the PHS Guidelines are for cytomegalovirus (CMV) infection. CMV is a herpes virus that can cause illness, most commonly when the T-cell count is less than 50. CMV can cause retinitis, an eye infection that can lead to loss of vision. Standard treatment for CMV involves drugs given intravenously. Once someone has had CMV, ongoing, or maintenance treatment is needed to prevent the CMV infection from becoming active again. Several studies have now shown that when CD4-cell counts increase to over 100-150 cells, maintenance treatment for CMV may not be as necessary. The PHS Guidelines are cautious about this information, because active CMV disease can be very serious. The updated guidelines say that stopping maintenance treatment may be considered if there is a sustained CD4-cell increase to over 100-150 cells. Any decision to stop CMV maintenance therapy should be made in consultation with an eye doctor, or ophthalmologist who's familiar with CMV. The ophthalmologist will take a number of factors into account, including how threatening the CMV infection may be to the person's vision.
\|\|\|\|\| Stopping maintenance treatment for Cryptococcosis:
For people who have had Cryptococcosis infection it's necessary to take treatment to prevent it coming back (this is called maintenance treatment). The 2001 guidelines say stopping Crypto prophylaxis can be considered if the CD4-cell count increases to over 100-200 cells for at least 6 months, if the individual have completed initial treatment of Crypto therapy and have no symptoms of the disease. The new PHS Guidelines for the Prevention of Opportunistic Infections can be found on the Internet at: http://www.hivatis.org/trtgdlns.html. This article appeared in the July 1999 issue of Body Positive, and has been updated to reflect changes in the 2001 OI guidelines by the Network. If you'd like more information about Body Positive's excellent monthly magazine, or their services, call them at (212) 566-7333 or e-mail them at bodypos@aol.com.