[HIV-associated Pneumocystis carinii pneumonia, primary pentamidine inhalation prophylaxis notwithstanding. Are there differences with Pneumocystis carinii pneumonia without prophylaxis?].

OBJECTIVE

To study the effect of pentamidine aerosol inhalation, known to be effective and well tolerated in the primary prevention of HIV-associated Pneumocystis carinii pneumonia (PCP), on the severity, on clinical and radiological findings and prognosis of break-through PCP.

PATIENTS AND

METHODS

Data were obtained from the case notes of 17 men (mean age 36 [23-55] years) with HIV-associated PCP, treated between 1989 and 1994, who had received primary prophylaxis with pentamidine aerosol. During the same period 42 patients with HIV-associated PCP but no pentamidine prophylaxis (39 men, three women; mean age 36 [21-67] years) were also treated. Bronchoalveolar lavage of the most affected segment was performed. Diagnostic measures and treatment remained constant during the period of observation.

RESULTS

The clinical presentation was the same in the two groups. There was also no difference between them regarding sensitivity to the lavage (94 and 98%). However, infiltration of the upper segments was significantly more common in the prophylaxis group (90 and 43%; P < 0.02). There was no statistically significant difference between the two groups in death rate (13 and 7%) and the long-term prognosis after PCP (survival time 18 and 24 months, respectively).

CONCLUSION

Primary prophylaxis of PCP had no significant effect other than altering the distribution pattern of the pneumonic infiltrates towards the apical segments.