Withdrawal of Pneumocystis prophylaxis: authors' reply
Bibliographic record
Abstract
We agree with Drs Zingman and Grossberg [1], and with the wealth of published literature available, that, in the setting of untreated HIV infection, the risk of developing Pneumocystis jiroveci pneumonia (PCP) is inversely correlated with CD4+ T-cell count. However, the key point and significance of our analysis [2] appears to have been missed. Unlike in untreated HIV infection, where there is an undisputed benefit of PCP prophylaxis when the CD4+ T-cell count is below 200 cells/μl, there were previously no published data available to indicate whether such prophylaxis was required when HIV replication is suppressed with effective combination antiretroviral therapy. From initial independent clinical observations, and then from the descriptive analysis conducted on our patient cohort, we have demonstrated that PCP prophylaxis may not be required in this latter setting. We would look forward to a prospective, randomized, controlled trial to definitively address this issue, but suspect that the results obtained in such a clinical trial will not be available in the near future. In the mean time, and with the limited available data, clinicians will need to weigh the risks and benefits of prescribing PCP prophylaxis for their patients on effective antiretroviral therapy and make decisions that they think serve the interests of their patients. Based on our collective clinical experience and our recently published report, we feel that PCP prophylaxis is not required in the setting of maximal viral suppression, irrespective of CD4+ T-cell count.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".