Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Reuters NewMedia - Wednesday April 28, 1999
Gene Emery

In the early days of the AIDS epidemic, a person with an immune system ravaged by the AIDS virus faced a 20 percent chance each year of developing Pneumocystis carinii, a then rare type of pneumonia.

Researchers later discovered medicines that would prevent the pneumonia, which arises when a class of infection-fighting white cells known as CD4 lymphocytes drops below 200 per cubic millimeters of blood.

Because doctors had no way to slow the deterioration of the immune system, the U.S. Public Health Service recommended patients take the pneumonia-preventing drugs for life.

But many who receive the new "AIDS cocktail" of protease inhibitors see their CD4 counts rise above 200, leaving doctors to wonder whether infected people still need to take anti-pneumonia drugs.

The answer appears to be no, according to the report. Drugs used to prevent pneumonia in AIDS patents include: trimethoprim-sulfamethoxazole, inhaled pentamidine, or dapsone, with or without pyramethamine, which is sold by Glaxo Wellcome Plc. (quote from Yahoo! UK & Ireland: GLXO.L) under the brand name Daraprim.

Using data from the Swiss HIV Cohort Study, a team led by Dr. Hansjakob Furrer of the Bern Hospital in Switzerland studied 262 volunteers whose immune systems had rebounded. All were taken off the pneumonia-preventing drugs.

The Furrer team found that as long as the CD4 counts remained over 200, none of the volunteers developed AIDS-related pneumonia. In addition there were no cases of toxoplasmic encephalitis, a serious AIDS-related brain infection, the study said.

The researchers said their results should be applicable to most people infected with Human Immunodeficiency Virus (HIV) that causes AIDS.

In an accompanying editorial, Drs. Henry Masur of the National Institutes of Health in Bethesda, Maryland, and Jonathan Kaplan of the Centers for Disease Control and Prevention in Atlanta said it is "reasonable" to discontinue the pneumonia-preventing drugs as long as a patient's CD4 counts stay above 200.

"The discontinuation of an inexpensive drug that is taken once daily may seem trivial," they said, but it may "provide a psychological benefit, by affirming" to patients that their immune system has gotten healthier.

Giving one less drug, they added, may also reduce the risk of developing strains of bacteria, fungi and protozoa that are resistant to current drugs.

Further studies are needed, Masur and Kaplan said, to determine if other drugs routinely given to prevent other AIDS-related infections can also be discontinued.
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