Masur H; Clinical Center, National Institutes of Health, Bethesda, MD.
Pneumocystis pneumonia is declining in frequency among men-who-have-sex-with-men, but not among intravenous drug abusers, suggesting that prophylaxis is effective if it is available to compliant patients. Among current prophylactic regimens, tolerance is an issue: on-going studies are assessing the role of desensitization to TPM-SMX in addition to using lower dose regimens. In addition to aerosal pentamidine and dapsone, new information about atovaquone prophylaxis should be available soon. Data regarding macrolide activity may also be pertinent. Major questions persist about the role of antiretroviral agents and immunomodulators for restoring immune competence as opposed to preventing immune incompetence. Failure of prophylaxis, especially trimethoprim-sulfamethoxazole, is related to CD4 count, compliance, and potentially to drug resistance. For therapy of pneumocystis pneumonia, promising newer agents include specific antipneumocystis compounds, such as pneumocandins, primaquine analogues, pentamidine analogues, and combination regimens with hydroxynaphthoquinones. Since some therapeutic failures appear to be due to immunologic incompetence, immunotherapy may also have a role. How clinically important trimethoprim-sulfamethoxazole resistance becomes is a vital issue as prophylaxis becomes more widespread and chronic.
Keywords: AEGIS, Pneumonia, Pneumocystis carinii, Pentamidine, Trimethoprim-Sulfamethoxazole Combination, Dapsone, Sjogren's Syndrome, Anti-Infective Agents, Naphthoquinones, Antiviral Agents, Antifungal Agents, Primaquine, Sezary Syndrome, atovaquone, Human, Male, prevention & control, therapy, drug therapy, AIDS
