In patients with AIDS and cryptococcosis, maintenance therapy with fluconazole is imperative until the CD4 cell counts are persistently above the cutoff level of 100/juL (e.g., for at least 6-12 months) and are a better predictive test with respect to a negative serum antigen result (25). The same is probably true for HIV-negative, immunosuppressed patients, and we suggest the use of peripheral CD4 cell counts even among SLE patients to guide the safe stopping of secondary prophylaxis. In the case reported by Sivalingam et al., no suppressive therapy was prescribed, and although they reported no disease relapse at 10-month follow-up, as infectious diseases specialists, we would have recommended it.
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