Which patients should consider chemoprophylaxis against Pneumocystis jiroveci pneumonia (PJP)?

Updated: Apr 24, 2019
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Unlike in patients with HIV infection, no specific PJP prophylaxis guidelines exist for immunocompromised patients without HIV infection. In general, chemoprophylaxis should be considered in any of the following patients:

  • Patients with an underlying primary immune deficiency (eg, severe combined immunodeficiency or hypogammaglobulinemia)

  • Patients with a persistent CD4 count less than 200/µL

  • Solid organ transplant recipients

  • Hematopoietic stem cell transplant (HSCT) recipients, with prophylaxis administered (1) for 6 months after engraftment months or (2) for more than 6 months after HSCT in those who are still receiving immunosuppressive therapy (eg, prednisone, cyclosporine) or who have chronic graft versus host disease

  • Patients receiving daily systemic corticosteroid therapy (at least 20 mg daily for at least 1 month)

  • Patients with cancer, vasculitides, or collagen vascular disorders and others receiving cytotoxic or immunosuppressive treatments such as cyclosporine or the purine analogs fludarabine or cladribine

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