PENTAMIDINE AEROSOL PROPHYLAXIS AGAINST P NEUMOCYSTIS-CARINII PNEUMONIA IN HIV-POSITIVE PATIENTS - A RETROSPECTIVE STUDY OF 465 CASES

Objectives: At least 80% of human immunodeficiency virus (HIV)-positiv e patients not given prophylaxis therapy against Pneumocystis carinii develop pneumonia, a major cause of morbidity and mortality. We theref ore retrospectively evaluated prophylaxis protocols given from March 1 988 to July 1991 at the Pasteur Institute Hospital. Methods: Pentamidi ne aerosols were prescribed for 456 HIV-positive patients as primary o r secondary prophylaxis. From March 1988 to November 1989 the dose was 4 mg/kg pentamidine mesylate once a month for primary prophylaxis and 4 mg/kg twice a month for secondary prophylaxis. From November 1989 p entamidine isethionate was given at the dose of 300 mg once a month. R esults: Tolerance was generally good, treatment had to be discontinued in only 2 of the 456 patients due to side effects. Pneumocystis carin ii pneumonia was diagnosed in 4.9% of the treated patients, but in onl y 2.9% of those who were compliant. Pneumocystis carinii pneumonia occ urred in very immunodepressed patients and radiologically appeared as an interstitial or alveolo-interstitial syndrome, often with a macrono dular element, in 65% of the patients. Conclusion: The results of this retrospective study confirm the prophylactic value of pentamidine aer osols given after trimethoprime-sulfamethoxasol.