United Press International - Wednesday, April 28, 1999
Ed Susman

Swiss researchers said Wednesday none of 262 patients taken off medication to prevent pneumocystis carinii pneumonia (PCP) suffered a bout of the illness, a deadly opportunistic infection frequently seen in immune-compromised patients, such as those infected with HIV.

"Historically, we would have expected to see about 8-10 cases of PCP in this group of patients," said lead investigator Dr. Hansjakob Furrer of the HIV Outpatient Clinic at the University Hospital of Bern. "This is the first time we have had convincing grounds for alleviating the treatment given to some HIV-infected patients."

In a report in Thursday's issue of the New England Journal of Medicine, Furrer and colleagues, working with the Swiss HIV Cohort Study, offered to take patients off PCP preventative medication if a key marker of immune system recovery -- CD4-positive lymphocytes -- increased to levels above 200.

Furrer said that when CD4 cell counts drop below 200, the risk of PCP rises to 10 to 20 percent a year; below 100 CD4 cells, the risk increases to 40 percent a year. His patients had CD4-positive counts between 200 and 500 cells, putting them at about a 6 percent yearly risk of PCP.

"We had more than 300 patients who were eligible to drop PCP prophylaxis in our group, but many decided they weren't willing to take the risk that PCP would return," Furrer told United Press International.

He said the study's main results are:

- Patients were able to reduce taking medication. "Most of the time, people living with HIV have to add about two pills to their daily regimen every year," he said. "This study will allow them to reduce the number of pills." PCP prophylaxis required three to seven pills a week.

"There is a great psychological boost to these patients knowing they can safely stop taking some medication," Furrer said.

- That the CD4 cells that rebound with patients on treatment with protease inhibitors and other antiretroviral medication are functioning cells.

"We have debated whether these rebounding CD4 cells really work to protect the body, whether they are functioning cells," said Furrer. "Our work would indicate that these are real cells and they represent a functioning reconstitution of the immune system," he said.

HIV infection degrades and destroys a person's immune function, reducing the immune system's ability to fight off opportunistic infections such as PCP. It is these infections which prove fatal in AIDS.

Furrer's study is consistent with an earlier finding in a smaller group of patients treated by Dutch doctors. Furrer said, "As far as we are concerned, we are now practically certain that fewer than 2 percent of our patients are likely to develop PCP."

Furrer presented preliminary data on his study at the World AIDS Conference in Geneva last year.

In an accompanying editorial in the journal, Dr. Henry Masur of the National Institutes of Health, Bethesda, Md., and Dr. Jonathan Kaplan of the Centers for Disease Control and Prevention, Atlanta, wrote:

"The report by Furrer and colleagues offers gratifying evidence that immune reconstitution resulting from highly active antiretroviral therapy may allow some patients to discontinue primary prophylaxis against PCP."

The doctors said further studies should attempt to define the risk of discontinuing the medication in other infected populations. Furrer said his group is continuing to perform such studies.

Furrer noted, however, that the possibility of PCP resurfacing more than a year after the prophylactic treatment has been discontinued cannot be entirely excluded. He further said the findings do not apply to patients who have previously had PCP.
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