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Abstract
PNEUMOCYSTIS CARINII PNEUMONIA IN THE INNER CITY: PERSISTENT OCCURRENCE AND HIGH MORTALITY. A REVIEW OF 488 CASES
C. Franco-Paredes1, P. Petraro2, M. Barragan1, F. Rhein2, G. Sanchez2, C. Del Rio1-2
1Emory University Center for AIDS Research, Atlanta GA, 2Grady Memorial Hospital (GMH), Atlanta GA, USA
Background: HAART has improved morbidity and mortality associated with opportunistic infections. However, Pneumocystis carinii pneumonia (PCP) remains a leading cause of mortality among patients with AIDS in the inner city. Among previously known HIV+ patients, PCP still occurs because of inadequate access to care or poor adherence to therapy. Methods: Retrospective review of medical records of patients diagnosed with PCP at GMH, in Atlanta, GA to compare the characteristics of PCP during 2 periods: pre-HAART (1991-1995) and HAART (1996-2001). Results: There were 492 confirmed episodes of PCP among 488 patients: 234 pre-HAART and 254 HAART. Mean age was 36 years and 14% were women (32/234 pre-HAART vs. 44/25 HAART; p=0.24). There was a significant decrease in PCP cases among Caucasians during the HAART period (57/234 vs. 41/254; p=0.04). Severe immunosuppresion was present at the time of PCP diagnosis (median CD4 count 18 cells/μL; 21 vs. 15; p= NS). PCP was the initial presentation of HIV in 38% (186/488) with no difference between periods (92/234 vs. 94/254; p=0.9) and 48% (90/186) of them died during that hospitalization (48/234 vs. 42/254; p=0.9). ICU care occurred in 145 episodes with 86% (124/145) requiring intubation for respiratory failure. Most patients (84%) admitted to the ICU died. However, fewer died during the HAART period (53/63 vs. 69/82; p=0.001). Among those known to be HIV+ prior to the episode of PCP, only 50% (151/302) had been prescribed PCP prophylaxis. During the HAART period only 44% (71/160) of patients know to be HIV-infected had been prescribed HAART prior to the episode of PCP. Conclusions: PCP continues to affect inner city populations in the US. Neither the introduction of HAART nor PCP prophylaxis have impacted this population. Due to advanced immunosuppression at time of presentation with PCP, mortality is extremely high. Public health resources should be targeted to these communities to diagnose HIV infection at an earlier stage.
The 2nd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
950
Suggested Citation
" C. Franco-Paredes , et al.
PNEUMOCYSTIS CARINII PNEUMONIA IN THE INNER CITY: PERSISTENT OCCURRENCE AND HIGH MORTALITY. A REVIEW OF 488 CASES.
Poster:
The 2nd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
950"
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