Stopping Primary Prophylaxis in HIV-1-Infected Patients at High Risk of Toxoplasma Encephalitis [Furrer H, et al. Lancet 2000;355:2217]: This report from the Swiss HIV Cohort Study addresses the discontinuation of primary prophylaxis for toxoplasmosis in patients infected with HIV-1 who had immune reconstitution to a CD4 count of at least 200/mm³ for a minimum of 12 weeks. Once prophylasix was stopped, there were no cases of toxoplasma encephalitis among 199 patients with a follow-up of 272 patient-years.
Comment: This is yet another study of the efficacy of stopping prophylaxis for opportunistic infections when immune reconstitution is achieved with antiretroviral therapy. It is noteworthy that 2/3 of the participants had viral loads <200 copies/mL at the time that prophylaxis was discontinued; it is not clear that the same results would be achieved with uncontrolled viremia. posted 7/6/2000