PRIMARY AND SECONDARY PROPHYLAXIS OF PNEU MOCYSTIS-CARINII PNEUMONIA WITH PENTAMIDINE AEROSOL - EFFICACY, SIDE-EFFECTS AND FREQUENCY OF EXTRAPULMONARY PNEUMOCYSTIS-CARINII MANIFESTATION

Background: We report on a retrospective study in 544 HIV-positive pat ients, (42 women, 502 men, mean age 35 years) showing CD4 lymphocyte c ounts below 200 c/mcl or after their cure of Pneumocystis carinii pneu monia, who received 300 mg pentamidine aerosol as prophylaxis against Pneumocystis carinii pneumonia every four week. Patients and methods: 277 patients were asymptomatic, 120 in the AIDS related complex stage (ARC) and 147 in the full stage of AIDS. The mean follow-up was 14,4 m onths. Results: A total of 25 cases of Pneumocystis carinii pneumonia was observed (3.83/year): in the primary prophylaxis group 18 (3,25%/y ear), in the secondary prophylaxis group seven (6,8%/year). By introdu cing the loading dose (one inhalation per day for five consecutive day s for patients with CD4 cell counts below 150 c/mcl) we reduced the pe rcentage of early manifestations within the first three months from 61 % to 14%. No extrapulmonary Pneumocystis carinii manifestation was obs erved. Conclusion: This study supports the efficacy of pentamidine aer osol prophylaxis of primary and secondary Pneumocystis carinii pneumon ia.