Pneumocystis carinii Pneumonia in HIV-Infected Patients in the HAART Era

Abstract

Since the advent of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections (OI) in patients with HIV has markedly decreased. Despite this, there are still large numbers of Pneumocystis carinii pneumonia (PCP) cases at Cook County Hospital (CCH). To better understand this patient group, we performed a retrospective chart review of 120 pathologically proven cases of PCP from January 1998 to June 2001. One hundred four patients were included in the study. Sixty-nine percent of our patients were active substance abusers and 50% had previous knowledge of HIV disease. Of our patients, fewer than 5% were on HAART or PCP prophylaxis on study admission. The overall mortality rate was 14%. Of discharged patients, 65% were placed on HAART therapy and 59% of these achieved a viral load of less than 1000 copies per milliliter in the year postdischarge. Patients who failed to achieve a viral load less than 1000 copies per milliliter were more likely active substance abusers or had a viral load greater than 100,000 copies per milliliter prior to study admission. Our study shows that patients are still being admitted with PCP in the HAART era. Active substance abuse and failure to recognize HIV status contributed heavily to this late presentation of HIV disease. An aggressive approach toward HIV identification and substance abuse treatment may decrease admissions to the hospital for PCP and improve response to HAART therapy.

Pulmonary infections in HIV-infected patients: an update in the 21st century

“…Despite this decrease, PCP remains the most common AIDS-defining indicator condition and the most frequent opportunistic infection in North America and Europe [27]. Nevertheless, P. jirovecii pneumonia still occurs in persons who are not receiving either HAART or anti-PCP prophylaxis; a significant percentage of these patients (up to 50%) are not known to be infected with HIV [68]. This situation emphasises the importance of performing an early diagnosis of HIV infection, especially in patients at risk [5,68].…”

“…Certain strains of P. jirovecii have mutations in the dihydropteroate synthase (DHPS) gene, an essential enzyme that is inhibited by sulfonamides. The DHPS mutation is associated with the use and duration of TMP-SMX prophylaxis, but it is not related to a possible failure of TMP-SMX treatment and a worst prognosis [68,[80][81][82]. Once immunological response is documented and sustained with the use of HAART (CD4 cell count increase .200 cells?mL -1 for at least 3 months), PCP prophylaxis may be discontinued [50,83].…”

“…Most investigations have focused on PCP, and a mortality of 10-30% has been reported [14,15,68,161]. There has been little change in mortality over the past 20 yrs [14,161].…”

HIV-Associated Lung Infections and Complications in the Era of Combination Antiretroviral Therapy

“…Two factors-the use of combination ART and Pneumocystis prophylaxis-have combined to dramatically reduce the number of cases of PCP. Nevertheless, PCP continues to occur, chiefly among persons who are unaware of their HIV infection, those who fail to seek medical care, and those who fail to adhere to or respond to ART or Pneumocystis prophylaxis (26)(27)(28).…”

Pneumonia in HIV-Infected Patients

“…Thus, patients are still being admitted with PCP in the HAART era. An aggressive approach toward HIV identification and substance abuse treatment may decrease admissions to the hospital for PCP and may improve response to HAART therapy (29).…”