PNEUMOCYSTIS-CARINII PNEUMONIA IN VERTICALLY ACQUIRED HIV-INFECTION IN THE BRITISH-ISLES

In order to review the clinical course, laboratory findings, and outco me of children with vertically acquired HN infection and Pneumocystis carinii pneumonia, questionnaires were sent to paediatricians in the B ritish Isles who had reported P carinii pneumonia and HIV infection th rough the British Paediatric Surveillance Unit (BPSU). Paediatric repo rts from the BPSU are Linked to reports of pregnancies in HIV positive women and laboratory reports. P carinii pneumonia was the most freque ntly reported AIDS indicator disease at AIDS diagnosis, occurring in 2 2/56 (40%) children born in the British Isles; in a further two childr en P carinii pneumonia occurred after another AIDS indicator disease. The median age at P carinii pneumonia diagnosis was 4.1 (1.4-27.3) mon ths and in 48% it occurred with other AIDS indicator diseases. Despite intensive treatment the three month survival was only 38%. The nine c hildren surviving P carinii pneumonia subsequently developed further A IDS indicator diseases, in particular HIV encephalopathy and four have since died. P carinii pneumonia was present at AIDS diagnosis in 65% of children developing AIDS in the first year of life and caused 82% o f infant deaths. Most children were not known to be at risk of HIV unt il they presented with P carinii pneumonia. Children with HIV infectio n develop P carinii pneumonia at an early age and have a poor outcome. Increased awareness of the condition is required to initiate early tr eatment. Prevention may be a compelling incentive for screening in pre gnancy, but further study is required to quantify the risks and benefi ts of initiating early P carinii pneumonia prophylaxis as well as the impact this might have on life expectancy.