NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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For primary prophylaxis of PJP in HIV, when should treatment be discontinued?

CD4<200
When taking fully suppressive ART
CD4>200 for >3 months on ART
After completion of a 21-day regimen

The correct answer is: CD4>200 for >3 months on ART

For primary prophylaxis of PJP (Pneumocystis jirovecii pneumonia) in HIV-infected patients, treatment should be discontinued once the patient has achieved a sustained increase in CD4 count to above 200 cells/mm³ for more than 3 months while on antiretroviral therapy (ART). This is because a CD4 count above 200 cells/mm³ indicates a sufficient level of immune reconstitution, reducing the risk of opportunistic infections like PJP. Options A and D are incorrect because they do not take into consideration the importance of sustained immune recovery indicated by a CD4 count above 200 cells/mm³ for more than 3 months on ART. Option B is incorrect because simply being on fully suppressive ART does not necessarily mean that the patient's immune system has fully recovered to a CD4 count above 200 cells/mm³ for an extended period, which is the critical factor in determining when to discontinue PJP prophylaxis.