PJP Prophylaxis HSCT cGVHD — SCE Infectious Diseases MCQ

Correct answer: B — Continue prophylaxis beyond the routine post-transplant minimum while clinically important immunosuppression persists with review

The best answer is “Continue prophylaxis beyond the routine post-transplant minimum while clinically important immunosuppression persists with review”. Ongoing multi-agent immunosuppression maintains Pneumocystis risk, so a calendar date alone is not an adequate stopping rule. “Stop prophylaxis at exactly 6 months regardless of ongoing treatment” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Reserve prophylaxis for people with HIV only” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Start prophylaxis only after a first Pneumocystis episode” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use no prophylaxis because it increases fungal pneumonia” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: BHIVA pulmonary opportunistic-infection guideline 2024: https://bhiva.org/clinical-guideline/oi-guidelines-pulmonary/