AEGiS-14IAC: Pneumocystis carinii pneumonia in the highly active antiretroviral era: increased prevalence in people of color.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Pneumocystis carinii pneumonia in the highly active antiretroviral era: increased prevalence in people of color.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10250)

O'Brien JG, Gooze L, Lee SA, Nix D
Santa Clara Valley Health and Hospital System, University of California, San Francisco, University of Pacific, San Jose, CA, United States

BACKGROUND: In the past few years, patients unaware of their HIV status have presented with moderate to severe pneumocystis carinii pneumonia (PCP). Of interest PCP cases seemed to cluster at certain times of the year. We assessed the changing demographics and apparent clustering of cases from January 1996 through December 2000.

METHODS: A retrospective review of medical records from HIV positive patients with histologically confirmed PCP was conducted. Patient ethnicity, adherence to PCP prophylaxis and HAART, and PCP as HIV defining event were collected. Rainfall data was quantized by quartile and by a priori intervals while number of PCP cases was quantized. Fisher exact test and Spearman rank-order tests were utilized for statistical analysis.

RESULTS: 64 cases occurring in 62 patients were included in the analysis. Twenty one (78%) of 27 patients were patients of color in 1999-2000 versus 19 (54%) of 35 patients in the 1996-98 period. Ethnicity of patients presenting with PCP over time demonstrated a shift from primarily Caucasian in 1996-98 to mostly Latinos in 1999-2000 which was statistically significant (p<0.05 Fisher exact test). Examining the number of PCP cases/month by monthly rainfall level revealed a statistically significant increase in the number of PCP cases with increased rainfall (p<0.05, Fisher exact test; p<0.05 Spearman non-zero correlation). HIV/AIDS was newly diagnosed with concomitant PCP in 60% of patients compared to 42% in 1999-2000 and 1996-98. Adherence was a particular problem; of 13 patients who were prescribed PCP prophylaxis, only one was adherent.

CONCLUSION: There is a need for enhanced interventions to prevent PCP, encourage patients of color to be tested for HIV and to seek care. The poor adherence with PCP prophylaxis could have implications for adherence to HAART medication. The statistically significant correlation of number of PCP cases as a function of rainfall deserves further prospective study.

Keywords: AEGIS, Pneumonia, Pneumocystis, Prevalence, Antiretroviral Therapy, Highly Active, HIV Infections, Acquired Immunodeficiency Syndrome, HIV, Anti-HIV Agents, Prospective Studies, Retrospective Studies, Color, Demography, Human, epidemiology

020707
B10250