RECENT TRENDS IN PNEUMOCYSTIS-CARINII PNEUMONIA AS AIDS-DEFINING DISEASE IN 9 EUROPEAN COUNTRIES

We analyzed the proportion of AIDS cases with Pneumocystis carinii pne umonia (PCP) at diagnosis among the 43,198 adult AIDS cases diagnosed since January 1988 and reported by June 1992 in Austria, Belgium, Fran ce, Germany, Italy, Portugal, Switzerland, United Kingdom, and the cit y of Amsterdam. In multivariate analysis, the risk of having PCP at AI DS diagnosis decreased slightly with increasing age and was strongly a ssociated with country of diagnosis, transmission category, and year o f diagnosis, but not with gender. Since 1989, the proportion of AIDS c ases with PCP decreased significantly among homosexual and bisexual me n in five of the nine countries examined and among injecting drug user s in four of seven countries. In three countries with sufficient data for analysis, no significant decrease was seen among heterosexual pati ents with a partner originating from a country where heterosexual tran smission is common (i.e., Africa/Caribbean). Among other heterosexual patients, a significant decreasing trend was demonstrated in only one of six countries analyzed. For all countries combined, the decrease wa s significant among hemophiliacs and of borderline significance among transfusion recipients. Results suggest that medical management before AIDS diagnosis is not homogeneous among all human immunodeficiency vi rus (HIV)infected persons in Europe. Efforts should be made to provide better information on the potential benefit of early HIV testing and to facilitate the use of preventive treatments.