Clinical aspects of Pneumocystis carinii pneumonia in HIV-infected patients: 1997.

In 1997 in Europe P. carinii pneumonia is largely a disease of individuals who are either unaware of their HIV serostatus or who decline prophylaxis despite knowing they are HIV positive. Although fibre optic bronchoscopy and bronchoalveolar lavage is the diagnostic 'gold standard' polymerase chain reaction (PCR) amplification applied to oropharyngeal washings appears to have a moderate to high diagnostic yield. With further development this may provide a truly non-invasive diagnostic test. There is a clear need for an inherently more effective regimen for prophylaxis both for those with adverse reactions (ADR) to co-trimoxazole and also for those with low CD4 lymphocyte counts. Ideally, new drug regimens should afford cross-prophylaxis against bacterial, mycobacterial and other fungal infections. Given the high frequency of ADR to co-trimoxazole when used as treatment for P. carinii pneumonia, there is also a need for effective, non-toxic alternative therapies.