HIV-ASSOCIATED PNEUMOCYSTIS-CARINII PNEUM ONIA WITH AND WITHOUT PRIMARY PROPHYLAXIS WITH PENTAMIDINE INHALATION - ARE THERE DIFFERENCES

Objective: To study the effect of pentamidine aerosol inhalation, know n to be effective and well tolerated in the primary prevention of HIV- associated Pneumocystis carinii pneumonia (PCP), on the severity, on c linical and radiological findings and prognosis of break-through PCP. Patients and method: Data were obtained from the case notes of 17 men (mean age 36 [23-55] years) with HIV-associated PCP, treated between 1 989 and 1994, who had received primary prophylaxis with pentamidine ae rosol. During the same period 42 patients with HIV-associated PCP but no pentamidine prophylaxis (39 men, three women; mean age 36 [21-67] y ears) were also treated. Bronchoalveolar ravage of the most affected s egment was performed. Diagnostic measures and treatment remained const ant during the period of observation. Results: The clinical presentati on was the same in the two groups. There was also no difference betwee n them regarding sensitivity to the lavage (94 and 98%). However, infi ltration of the upper segments was significantly more common in the pr ophylaxis group (90 and 43%; P < 0.02). There was no statistically sig nificant difference between the two groups in death rate (13 and 7%) a nd the long-term prognosis after PCP (survival time 18 and 24 months, respectively). Conclusion: Primary prophylaxis of PCP had no significa nt effect other than altering the distribution pattern of the pneumoni c infiltrates towards the apical segments.