Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
PNEUMOCYSTIS CARINII PNEUMONIA
Infect Dis Ther; 3:317-40 1989. Unique Identifier : AIDSLINE ICDB/90665452 Wofsy CB; Dept. of Infectious Diseases, San Francisco General Hosp., San; Francisco, CA
Abstract:
In the setting of AIDS, Pneumocystis carinii pneumonia (PCP) has become a routinely encountered infection. PCP is the index AIDS diagnosis in approx 60% of patients (pts) and occurs at some time during the course of the illness in 80-85% of all pts with AIDS. This infection is restricted almost exclusively to the lungs, unlike other AIDS-defining opportunistic infections, which tend to be widely disseminated. PCP is reviewed under the following headings: epidemiology, diagnosis (symptoms, initial evaluation of pulmonary symptoms, evaluation of the pt with suspicious symptoms but normal chest x-ray findings, identifying the etiology of pulmonary disease with induced sputum and bronchoscopy, and empiric diagnosis), treatment (AIDS pts vs other immunocompromised pts, parenteral therapy with trimethoprim-sulfamethoxazole and pentamidine isethionate, oral therapy with trimethoprim + dapsone and trimethoprim-sulfamethoxazole, other therapies [trimetrexate, difluoromethylornithine, primaquine + clindamycin], and aerosol pentamidine), approach to therapy (mild to moderate disease, moderate to severe disease, use of the intensive care unit, duration of therapy, and cross toxicity), and prevention (trimethoprim-sulfamethoxazole, pentamidine, fansidar, dapsone, and aerosol pentamidine). Trimethoprim-sulfamethoxazole and pentamidine isethionate have been the established therapies for PCP in all immunocompromised pts; approx 50% of pts treated with pentamidine experience major side effects. Unlike other immunocompromised pts, however, more than 50% of pts with AIDS and PCP develop a major adverse reaction to trimethoprim-sulfamethoxazole, sufficient to require a switch to pentamidine. Relapse of PCP is very common in pts with AIDS. When 74 pts with first-episode PCP were evaluated in one study, relapse rates were 18% at 6 mo, 46% at 9 mo, and 65% at 18 mo when no suppressive therapy was given. There is considerable variability in the use of primary prophylaxis for PCP, but there is agreement that secondary prophylaxis should be instituted in most pts. (56 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Bronchoscopy Comparative Study Dapsone/THERAPEUTIC USE Drug Therapy, Combination Human Pentamidine/THERAPEUTIC USE Pneumonia, Pneumocystis carinii/*DIAGNOSIS/DRUG THERAPY Risk Factors Sputum/PARASITOLOGY Trimethoprim/THERAPEUTIC USE Trimethoprim-Sulfamethoxazole Combination/THERAPEUTIC USE JOURNAL ARTICLE REVIEW, TUTORIAL REVIEW 901030
M90A0684
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
