AEGiS-11IAC: Risk factors for Pneumocystis carinii pneumonia: delayed diagnosis of HIV-infection and failure to receive prophylactic therapy.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Risk factors for Pneumocystis carinii pneumonia: delayed diagnosis of HIV-infection and failure to receive prophylactic therapy.

Int Conf AIDS 1996 Jul 7-12; 11:230 (abstract no. Tu.B.114)
Duchin JS, Sohlberg B, Buskin S, Hopkins S, Simon P; Seattle-King County Dept. of Health, Seattle, WA. Fax: (206) 296-4803. E-mail: jsd@wonder.em.cdc.gov.

OBJECTIVES: Pneumocystis carinii pneumonia (PCP) is the leading serious opportunistic infection (OI) among persons with HIV. The importance of delayed diagnosis of HIV and lack of PCP prophylaxis as risk factors for PCP are poorly defined. We studied the timing of HIV diagnosis and use of PCP prophylaxis as risks for PCP.

METHODS: The Seattle Adult Spectrum of HIV-related Diseases Study conducts abstractions of medical records of HIV-patients including a one year retrospective baseline review and every six months thereafter at nine outpatient sites, and includes approximately 40% of local residents with AIDS; men of color and women are over sampled. Persons with initial episodes of PCP and no prior HIV test, OI, or CD4+ count were considered to have PCP at HIV diagnosis. To identify persons with known HIV not taking PCP prophylaxis, data from persons with initial episodes of PCP and at least two consecutive study intervals were analyzed.

RESULTS: Initial episodes of PCP were identified in 543 persons; of these, the mean age was 35 years, 95% were men, 427 (79%) were white, 66 (12%) black, 357 (66%) were men having sex with men, and 57 (10%) were injecting drug users. Of these 543 persons, 131 (24%) had PCP at HIV diagnosis, including 125 (26%) of 485 persons diagnosed at public facilities, compared to 5 (9%) of 58 persons diagnosed at a private clinic (p=0.004). There were no significant differences in the proportions of persons with PCP at HIV diagnosis by HIV-risk factor, race or gender. Among 195 persons with initial episodes of PCP, known HIV, and CD4+ counts (cells/microliter) within 6 months of PCP, 44 (23%) had no record of PCP prophylaxis (median CD4+, 79; 33 [75%] less than 200) and 151 had prior PCP prophylaxis (median CD4+, 33; 143 [95%] less than 200).

CONCLUSIONS: A large proportion of initial episodes of PCP may be due to either delayed diagnosis of HIV, or, among patients with known HIV, failure to receive PCP prophylaxis. The reasons for delayed diagnosis of HIV and failure to receive PCP prophylaxis need to be determined to improve early identification and treatment of persons at risk. The roles of noncompliance with, and intolerance to, PCP prophylaxis regimens among persons developing PCP despite prescribed prophylaxis should be examined.

Keywords: AEGIS, Pneumonia, Pneumocystis carinii, HIV Infections, CD4 Lymphocyte Count, HIV, Risk Factors, Retrospective Studies, Acquired Immunodeficiency Syndrome, Antiretroviral Therapy, Highly Active, HIV Antibodies, Human, Male, Female, Adult, diagnosis, therapy, drug therapy, ICA11

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