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Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%

HCPCS code

Name of the Procedure:

Pneumocystis jiroveci Pneumonia (PJP) Prophylaxis
Technical term: G9223


Pneumocystis jiroveci Pneumonia (PJP) Prophylaxis is a preventive treatment given to patients with weakened immune systems, specifically to avoid a serious lung infection caused by the fungus Pneumocystis jiroveci. This treatment involves prescribing medication to prevent the infection in patients whose immune systems are compromised.


Medical Conditions or Problems Addressed:
  • Low CD4+ cell count below 500 cells/mm³
  • CD4 percentage below 15%

    Goals or Expected Outcomes:
  • Preventing the occurrence of Pneumocystis jiroveci pneumonia in immunocompromised patients.
  • Reducing the risk of severe lung infections and related complications.


Specific Symptoms or Conditions:
  • HIV/AIDS with a CD4+ cell count below 500 cells/mm³ or CD4 percentage below 15%.
  • Other conditions leading to a weakened immune system that significantly lowers CD4+ cell counts.
Patient Criteria:
  • Recent diagnostic evidence showing low CD4+ cell count or percentage.
  • Patients within the first three months of identified immune suppression.


Pre-procedure Instructions:
  • Ensure regular follow-ups and blood tests to monitor CD4+ levels.
  • Report any other medications being taken to avoid drug interactions.
Diagnostic Tests:
  • Blood tests to measure CD4+ cell count and CD4 percentage.
  • Regular monitoring to assess immune function efficacy.

Procedure Description

Steps Involved:
  1. Assessment: Confirm the patient’s CD4+ cell count or percentage through blood tests.
  2. Prescription: Depending on individual factors, medications such as TMP-SMX (Trimethoprim/Sulfamethoxazole) or alternatives like dapsone or atovaquone are prescribed.
  3. Monitoring: Regular follow-ups to monitor CD4+ levels and assess side effects or efficacy of the prophylaxis.
Tools and Equipment:
  • Blood test kits
  • Prescribed prophylactic medications
Anesthesia or Sedation:
  • Not applicable, as the procedure involves medication management.


  • The treatment is ongoing but regularly evaluated, typically for as long as the CD4+ count remains below the thresholds.


  • Outpatient basis, typically managed through regular clinic visits.


  • Primary care physician
  • Infectious disease specialist
  • Nurses for administering blood tests

Risks and Complications

Common Risks:
  • Allergic reactions to medications
  • Gastrointestinal symptoms like nausea, vomiting, or diarrhea
Rare Risks:
  • Severe allergic reactions (e.g., Stevens-Johnson syndrome)
  • Hematological conditions such as anemia
  • Regular monitoring and adjustment of medication based on patient tolerance and response.


  • Significantly lowers the risk of developing Pneumocystis jiroveci pneumonia.
  • Improves overall health and quality of life for immunocompromised patients.
  • Benefits can be realized relatively quickly, often within the first few months.


Post-procedure Care:
  • Regular blood tests to monitor CD4+ levels.
  • Immediate reporting of any side effects or unusual symptoms.
Expected Recovery Time:
  • No specific recovery time; it's an ongoing preventive measure.
  • Patients may need to continue prophylaxis indefinitely until immune function improves.


Other Treatment Options:
  • Other prophylactic medications like dapsone or atovaquone if TMP-SMX is not tolerated.
  • No prophylaxis, with increased monitoring and immediate treatment if pneumonia develops.
Pros and Cons:
  • Other Medications: May have fewer side effects for some patients but might be less effective.
  • No Prophylaxis: Avoids drug side effects but entails a higher risk of developing a serious infection.

Patient Experience

During the Procedure:
  • Typically involves taking regular medication, with no invasive procedures.

    After the Procedure:
  • Ongoing medication adherence and monitoring are crucial.
  • Some patients may experience mild side effects, which can often be managed with the help of healthcare providers.
Pain Management and Comfort:
  • Generally, no pain is associated with the procedure itself.
  • Supportive care for managing any side effects of the medication.

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