Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

PCP PROBLEMS - CONTROVERSIES 1996

Jens D. Lundgren
Department of Infectious Diseases (144), Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. 5.1
AIDS 1996, Vol. 10 (Suppl. 2);S4

Despite intensive research, several problems remain for this major complication of the HIV infection. How is the microorganism transmitted? There is an increasing body of evidence to suggest that P. carinii can be transmitted via air. Whether PCP patients should be placed in isolation remains controversial, but might be advisable in departments with other susceptible patients. Primary prophylaxis - when and how? Despite widespread introduction of primary prophylaxis, PCP remains the leading complication of the chronic HIV infection. Primary prophylaxis is effective, but patients fail the prophylaxis because of variable efficacy, intolerance, and poor patient compliance. Furthermore, not all at-risk patients are identified before developing PCP. Earlier diagnosis? In the end of the 1980's, prognosis from an episode of PCP improved as a result of earlier diagnosis in the course of the pneumonia. Newer methods of detection have been developed, e.g. monoclonal antibodies and PCR, but the pneumonia remains problematic to diagnose. Treatment of PCP? Choice of antimicrobial therapy may be limited because of a prior allergy to sulfa-compounds or ongoing use of potentially pancreatoxic drugs preventing the use of parenteral pentamidine. Newer anti-PCP regimens may be less effective compared to co-trimoxazole and i.v. pentamidine, especially if the pneumonia is severe. Adjunctive steroids should be started simultaneously with the antimicrobial therapy in moderately to severely ill patients. However, dose, length of treatment, and possible side effects of steroids have not been clearly defined. Finally, a significant portion of patients may not improve on therapy. Whether this is due to antimicrobial resistance, diffuse non-reversible lung damage, or co-infection is often difficult to separate. When failing therapy late, admission to the ICU for mechanical ventilation needs careful evaluation. Secondary prophylaxis? Is associated with improved survival, but choice of drugs is limited. In conclusion, better prophylactic and therapeutic agents, antimicrobial sensitivity testing assays, improved diagnostic ability, and more understanding of the transmission of P. carinii are urgently needed.

Presenting author: Jens D. Lundgren

1996-11-03
5.1

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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