1501. Absolute CD4 Count and Percentage Discordance Impacting Pneumocystis Jirovecii Pneumonia (PJP) Prophylaxis in HIV-Infected Patients
Session: Poster Abstract Session: HIV and Co-infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Abs CD4 and percentage discordance impacting PJP prophylaxis poster.pdf (456.9 kB)
  • Background:

    Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against PJP if they have a CD4 count less than 200cells/μL or oropharyngeal candidiasis. Guidelines also recommend that persons with a CD4 percentage (CD4%) below 14% should be considered for prophylaxis. Discordance between CD4 count and CD4% occur in 16%-25% of HIV-infected patients. This study was conducted to assess provider compliance with current PJP prophylaxis guidelines when such discordance is present.


    Electronic medical records of HIV-infected patients who had CD4 count and CD4% measured at our clinic from July 2010 to April 2011 were reviewed. Patients with CD4 count >200, but CD4% <14 were defined as Discordance A (Dis-A) and conversely CD4 count < 200 but CD4% > 14 defined as Discordance B (Dis-B). We assessed whether these patients were on any form of PJP prophylaxis, developed PJP, received antiretroviral therapy, or had any hospital admissions for respiratory illnesses other than PJP. Odds ratios were calculated and Fisher’s exact test was used to assess associations for categorical variables.


    A total of 429 HIV-infected individuals had CD4 cell count and CD4% measured during the study period. Median age was 46 (Range 18-87 years), 53.0% Male, 81.0% non-Hispanic Black, 15.0% Hispanic and 2.0% White. CD4 count and percentage discordance was seen in 57/429 (13%). 28/429 had Dis-A and 29/429 had Dis-B. Dis-A participants were significantly less likely than Dis-B participants to be prescribed PJP prophylaxis (29% vs. 86%; OR = 0.064, 95% CI: 0.0168-0.2436; p-value <0.0001). One patient in the Dis-A group who was receiving ART with CD4 count of 680 cells/μL and CD4% of 6%, had presumed PJP.


    In this study, the use of PJP prophylaxis seemed to be determined more by the CD4 cell count than the CD4 percent.  Although our study is based on a retrospective medical record review, it forms a platform for further studies to better understand the clinical relevance of CD4 count and percentage in determining PJP prophylaxis.

    Henry Anyimadu, MD, FACP1,2, Bijal Doshi, MD3,4, Vel Sivapalan, MD, FACP4, Sharon Mannheimer, MD5 and Yael Hirsch-Moverman, PhD6, (1)Infectious Disease, Columbia University Affiliation At Harlem Hospital Center, New York, NY, (2)Medicine/Infectious Disease, St. Vincents Medical Center, Bridgeport, CT, (3)Columbia University Affiliation At Harlem Hospital Center, New York, NY, (4)Medicine/Infectious Disease, Columbia University Affiliation At Harlem Hospital Center, New York, NY, (5)Columbia Univ., New York, NY, (6)Charles P. Felton National Tuberculosis Center, ICAP, Mailman School of Public Health, Columbia University, New York, NY


    H. Anyimadu, None

    B. Doshi, None

    V. Sivapalan, None

    S. Mannheimer, None

    Y. Hirsch-Moverman, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.