Low incidence of Pneumocystis carinii pneumonia in HIV patients receiving 300 mg pentamidine aerosol every 2 weeks

Summary The optimal dosage of pentamidine for prophylaxis of Pneumocystis carinii pneumonia (PcP) is unknown. We assessed the effects of 300 mg pentamidine inhaled every 2 weeks. Salbutamol was added for prevention of bronchoconstriction. A total of 128 consecutive HIV patients were enrolled, 21 of whom were excluded within 8 weeks; the remaining 107 patients, 66 on primary and 41 on secondary prophylaxis, were treated for 39 weeks (median; range 8–133). Two patients developed PcP. Side effects occurred in only 14 of 5082 inhalations. Three patients developed hypoglycemia after inhalations. Blood glucose levels determined in 34 patients before and after inhalation revealed a decline from 89 ± 23 mg/dl to 79 ±23 mg/dl (P < 0.005). A randomized prospective trial is necessary to evaluate the efficacy of 300 mg pentamidine inhaled every 4 or 2 weeks.Abbreviation PcP Pneumocystis carinii pneumonia     

Disseminated infection ofPneumocystis carinii in a patient with the acquired immunodeficiency syndrome

Summary This report describes the histopathology of a disseminatedPneumocystis carinii infecton in a 24-year-old Japanese male haemophiliac diagnosed as having the acquired immunodeficiency syndrome. He developed respiratory symptoms, andPneumocystis carinii pneumonia was confirmed by transbronchial lung biopsy. On the 70th day of hospitalization the patient died. Autopsy findings revealedPneumocystis carinii not only in the lungs but also in the stomach, jejunum, ileum, colon, mesoappendix, abdominal lymph nodes, diaphragm, and thyroid gland.Contribution No. 627 from the Department of Medical Zoology, Kyoto Prefectural University of Medicine     

Survival of patients receiving zidovudine before or after AIDS diagnosis: results of a German multicenter study

While efficacy of zidovudine (ZDV) in the acquired immunodeficiency syndrome (AIDS) is well established, the issue of survival after early ZDV treatment is still controversial. To assess survival benefits of ZDV treatment prior to AIDS, as compared to treatment after the onset of AIDS, we used an observational analysis of infected individuals infected with human immunodeficiency virus treated with ZDV and/or prophylaxis against Pneumocystis carinii pneumonia prior to or after AIDS in comparison to patients never treated with ZDV Nine German AIDS treatment centers entered case reports dating from January 1988 to January 1992. A total of 1425 HIV-infected patients were included, mainly homo-/bisexuals: 1338 males and 87 females, with a mean age of 38.9 years. Of these, 262 had received ZDV prior to AIDS, 376 after AIDS, and 787 had never received ZDV Survival from a first CD4 lymphocyte count below 0.200 × 10⁹/1 (or below 0.500 × 10⁹/1) to death was assessed by means of Kaplan-Meier analysis. Survival did not differ significantly when the first CD4 count below 0.200 × 10⁹/1 was taken as baseline. The median survival of patients receiving ZDV prior to AIDS was 662 days as compared to 572 days in patients treated after AIDS. Patients with earlier therapy showed longer survival in a subset of patients who were observed from their first CD4 count below 0.500 × 10⁹/1. Additional PcP prophylaxis significantly improved survival in all groups. We conclude that survival from the first CD4 count below 0.200 × 10⁹/1 to death does not differ in patients receiving ZDV prior to or after AIDS. Additional PcP prophylaxis improves survival in ZDV-treated patients and patients without ZDVParticipating centers (order according to number of patient's files in the study): Kamps B, Brodt HR: Zentrum der Inneren Medizin, Universität Frankfurt; Arastéh K, Heise W: II. Innere Abteilung, Auguste-Viktoria-Krankenhaus, Berlin; Sadri 1, Goebel F-D: Medizinische Poliklinik, Universität München; Schedel I: Abteilung Immunologie, Medizinische Hochschule Hannover; Runge J, Schwander S: Bernhard Nocht Institut für Tropenmedizin, Hamburg; Jablonowski H, Szelenyi H: Medizinische Klinik and Poliklinik, Universität Düsseldorf; Emminger C, Loch O: IV Medizinische Abteilung, Krankenhaus München-Schwabing; Schöfer H, Hochscheid I: Zentrum der Dermatologie, Universität Frankfurt; Baumgarten R: Krankenhaus Prenzlauer Berg, Berlin     

Prevention of Pneumocystis carinii pneumonia and toxoplasmic encephalitis in human immunodeficiency virus infected patients: a clinical approach comparing aerosolized pentamidine and pyrimethamine/sulfadoxine

Summary The incidence of Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis (TE) was analyzed in 83 human immunodeficiency virus (HIV)-infected patients who inhaled aerosolized pentamidine (AP) either for primary prophylaxis (group la) or secondary prophylaxis (group IIa) of PCP. These cohorts were compared with two historical groups of patients who took Fansidar (pyrimethamine/sulfadoxine) for primary prophylaxis (group lb) or secondary prophylaxis (group IIb) of PCP. The follow-up was 3—41 months (median 8 months). PCP did not occur in group la but was seen in 1 patient of group Ib (5%). TE was observed in 3 patients of group Ia (7.3%) and in 1 patient of group Ib (5%). PCP relapses were seen in 5 patients of group IIa (11.9%) and in 3 patients of group Ilb (6.9%), whereas TE occurred in 13 patients of group IIa (30.9%) and in 1 patient of group IIb (2.3%). 20.3% of patients with CD4⁺ counts < 100/l and only 7.7% of those with CD4⁺ counts > 100/l developed toxoplasmosis. In conclusion, Fansidar rather than AP prophylaxis should be recommended for patients with a history of PCP or toxoplasmosis and for all HIV-infected patients with CD4⁺ counts 100/l. In patients with CD4⁺ lymphocyte counts between 100 and 200/l, AP prophylaxis appears appropriate.Abbreviations AIDS acquired immunodeficiency syndrome - AP aerosolized pentamidine - FDA Food and Drug Administration - HIV human immunodeficiency virus - IgG immunoglobulin G - PCP Pneumocystis carinii pneumonia - TE toxoplasmic encephalitis - TMP/SMX trimethoprim/sulfamethoxazole