Impact of primary prophylaxis for Pneumocystis carinii pneumonia and toxoplasmic encephalitis in a cohort of 1000 patients with AIDS
Monforte, A.D.; Mainini, F.; Bini, T.; Moscatelli, G.C.; Antinori, S.; Formenti, T.; Testa, L.; Mena, M.; Moroni, M.
Journal of ChemoTherapy 7(Suppl): 184-186
1995
ISSN/ISBN: 1120-009X PMID: 8904150 Document Number: 453310
A total of 1000 AIDS patients from Italy were included in an observational study to verify the impact of prophylactic regimens on the presentation of AIDS. P. carinii pneumonia (PCP) was diagnosed as index-disease of AIDS in 244 cases (24.4%), Candida spp. oesophagitis in 172 (17.2%), toxoplasmic encephalitis in 119 (11.9%), cytomegalovirus disease in 106 (10.6%), Kaposi's sarcoma in 91 (9.1%) and AIDS-dementia complex in 88 (8.8%). The annual incidence of PCP statistically decreased (P<0.005) and the incidence of toxoplasmic encephalitis increased (P<0.0001) according to the year of AIDS diagnosis. The rate of patients given pre-AIDS PCP prophylaxis increased from 5% in 1990 to 36% in 1993. Pre-AIDS prophylaxis with either aerosolized pentamidine (AP) or trimethoprim-sulfamethoxazole (TMP-SMX) resulted in a significant decrease of PCP at AIDS diagnosis. Median CD4+ cell count was lower in patients given than in patients not given prophylaxis before AIDS. No statistically significant variations in the frequency of toxoplasmic encephalitis were recorded in relation to previous prophylaxis with TMP-SMX. Of 85 patients initiating prophylaxis with TMP-SMX before AIDS, only 45 (53%) were still receiving the drug at AIDS diagnosis while 40 discontinued the administration because of side-effects.