Background Among patients infected with human immunodeficiencyvirus type 1 (HIV-1), early and widespread use of prophylacticregimens against Pneumocystis carinii is changing the patternof illnesses related to the acquired immunodeficiency syndrome(AIDS).
Methods We conducted a subcohort analysis of 844 men with AIDS(87 percent of whom have since died) from a prospectively followedcohort of 2592 HIV-1-infected homosexual men.
Results A total of 138 men received prophylaxis before the diagnosisof AIDS, but 39 (28 percent) nevertheless had P. carinii pneumoniaat some time. Only four illnesses occurred more frequently inmen who received P. carinii prophylaxis before the onset ofAIDS: Mycobacterium avium complex disease, which developed in33.4 percent, as compared with 17.3 percent of the 706 men whodid not receive early prophylaxis; wasting syndrome (18.4 percentvs. 6.4 percent); cytomegalovirus disease (44.9 percent vs.24.8 percent); and esophageal candidiasis (21.3 percent vs.12.8 percent). Collectively, these four diseases accounted forthe initial AIDS-related illness in 42.7 percent of those whoreceived prophylaxis before the onset of AIDS, as compared with10.7 percent of those who did not. During the three 6-monthperiods before the diagnosis of AIDS (0 to 6, >6 to 12, and>12 to 18 months), the geometric mean CD4+ cell counts were48, 87, and 147 per cubic millimeter, respectively, in men whoreceived prophylaxis against P. carinii, as compared with 118,211, and 279 per cubic millimeter in those who did not.
Conclusions M. avium complex disease, esophageal candidiasis,wasting syndrome, and cytomegalovirus disease are more commonin HIV-infected patients who have received prophylaxis againstP. carinii than in those who have not. Prophylaxis may delaythe first AIDS illness for 6 to 12 months.
Source Information
From the Departments of Epidemiology and Biostatistics, School of Hygiene and Public Health, Johns Hopkins University, Baltimore (D.R.H., A.J.S., H.B.); the Division of Infectious Diseases, Northwestern University Medical School, Evanston, Ill. (J.P.); the School of Public Health, UCLA, Los Angeles (R.D.); the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (R.A.); and the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (R.A.K.). Participating centers and investigators are listed in the Appendix.
Address reprint requests to Dr. Hoover at Johns Hopkins University, 624 N. Broadway, Suite 784, Baltimore, MD 21205.
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