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Primary and secondary prophylaxis for Pneumocystis carinii related complications in HIV patients.

At the beginning of the acquired immune deficiency syndrome (AIDS) era, nearly 15 yrs ago, Pneumocystis carinii pneumonia (PCP) was the most common human immunodeficiency virus (HIV)-related complication. PCP represented about 60% of the initial case-defining events of AIDS patients [1]. Almost 80% of HIV and AIDS patients experienced at least one episode of PCP in the course of their HIV infection [2, 3]. Thanks to secondary prophylaxis, the number of relapses of PCP has recently declined. But PCP is still the most commonly reported AIDS-associated diagnosis amongst HIV-infected individuals in Western industrialized countries [4]. Mortality was high, as the disease was not recognized early enough in many cases and the benefits of systemic steroids were not known at that point of time [5, 6]. Increased risks for PCP are: a CD4+ count 12 months of inhalation time) failure, and found no difference between these two groups. Presentation with upper lobe infections was also a radiographic pattern of late failures. EDELSTEIN and MCCABE [30] first described this atypical presentation in 1990 and, in contrast to EWIG et al. [28], they observed complicated courses, such as cavities and pneumothoraces. Lung cavitation in PCP may also occur without inhaled pentamidine prophylaxis [31]. EDITORIAL