LAUSR

Dear Editor, We read with interest Makinson et al.’s work [1], which found that opportunistic infection (OI) incidence rates in people with HIV (PWH) with cancer and controlled disease were similar to the incidence in HIVcontrols with solid cancers in a study nested in a veterans cohort. In these patients, pneumocystis infections were rare, and mostly undocumented, and no cases of toxoplasmosis were described. Among 909 PWH with CD4 counts >200/ mm and controlled viremia, only 2 possible pulmonary pneumocystosis (PCP) infections occurred, without microbiological confirmation. We found similar results in an analysis from the DAT’AIDS French national cohort in PWH with solid cancers between January 2005 and September 2018. Our study aimed to describe PCP and toxoplasmosis cases in PWH with successful virological control with CD4 levels >200/ mm who had been treated for solid malignancies. DAT’AIDS is a prospective cohort of 71 141 subjects that covers PWH treated in 23 French public hospitals, based on a computerized real-time medical record that is used by clinicians who collect demographic, behavioral, epidemiological, clinical, and biological information in a database using anonymous, coded identification numbers. All subjects included in the cohort received oral information and gave written consent (ClinicalTrials.gov NCT02898987). We used International Classification of Diseases, Tenth Revision, codes to retrieve types of solid nonhematological cancers, excluding Kaposi sarcoma and basal cell carcinoma, and PCP or toxoplasmosis infections. Among 1736 PWH with solid malignancies, 19 (1.1%) developed PCP, and none developed toxoplasmosis infection. All files of patients with PCP have been reviewed and validated. Only 4 PWH developed PCP during treatment despite HIV-controlled disease and CD4 levels >200 CD4/mm at malignancy diagnosis (data shown in Figure 1). Three had lung cancer, treated by chemotherapy for 1 (no available data on chemotherapy type), and 2 received a combination of radio-chemotherapy (carboplatin + pemetrexed followed by docetaxel for the first and cisplatin + etoposide and corticosteroids for the second). One had a thymoma treated by cisplatin + cyclophosphamide + doxorubicin followed by radiotherapy. Among patients with PCP, at cancer diagnosis the mean CD4 count was 544/ mm, and all viral loads were under the limit of detection. PCP occurred at a median of 306 days after cancer diagnosis. Only 1 PWH had a CD4 count <200 cells/ mm at PCP diagnosis, and only 1 had received prophylaxis with pentamidine nebulization. Two PCP diagnoses were considered certain, with compatible clinical and radiological presentations and isolation of pneumocystis DNA in respiratory samples. No information regarding immunofluorescence or betaDglucan was available. Open Forum Infectious Diseases