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Chart Review: Prophylaxis of Pneumocystis Pneumonia at a Large Metropolitan HIV Clinic.

Prophylaxis is imperative for Pneumocystis pneumonia (PCP), an important cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. Despite the availability of well-known prophylaxis guidelines and highly active antiretroviral treatment (HAART), PCP remains a leading opportunistic infection and an AIDS-defining diagnosis.1 Several antimicrobial agents are effective as prophylaxis against this organism, and prescribing differences are largely influenced by reports of allergies. 
 
We undertook a review of electronic medical records (EMRs) to determine whether the HIV clinic of the University of Pittsburgh Medical Center was complying with recommendations that PCP prophylaxis be prescribed for all HIV-infected persons with CD4 counts of below 200 cells/mm3.2We evaluated the prophylactic regimens of these patients to assess whether preventive measures were given and which regimen was used. We also recorded the relative proportions of the various regimens and assessed whether glucose-6-phosphate dehydrogenase (G6PD) testing was performed before dapsone was administered, given the concern about hemolysis in G6PD-deficient patients.3 The clinic, which treats approximately 1,500 HIV-infected individuals annually, is funded by the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.