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268 RESPIRATORY FAILURE DUE TO PNEUMOCYSTIS PNEUMONIA IS MORE COMMON IN INFANTS WITH AIDS THAN IN INFANTS WITH PRIMARY IMMUNODEFICIENCY

Purpose Despite differences in their underlying pathogenesis, the clinical outcomes, and prognosis of Pneumocystis jirovecii pneumonia (PCP) among infants with primary immunodeficiency (PID) and AIDS have not been examined. Methods A retrospective analysis of infants < 2 years of age treated for PCP and admitted to two tertiary care hospitals between 1985 and 2003 was performed. Infants were classified as having either HIV infection or PID. PCP was diagnosed based on positive silver methionine staining of bronchoalveolar lavage fluid, open biopsy, or tracheal aspirate. Outcome measures included the development of respiratory failure, as defined intubation with mechanical ventilation. Results Thirty-seven children were evaluated, 10 with PID and 27 with AIDS. The two groups did not differ in mean age, 5.8 ± 3.5 mo in the HIV group compared to 6.9 ± 2.8 mo in PID (p = .17). The two groups were not different with respect to sex, race, or ethnicity. Total T cell counts were similar in the two groups (784 ± 1232 in the HIV group compared to 871 ± 2767 in the PID group, p = .86). Respiratory failure occurred more frequently in the HIV group (22/27) than in the PID group (2/10)(p = .003). Conclusions PCP results in respiratory failure more often in infants with AIDS than infants with PID. While both groups are immune compromised, PCP and HIV co-infection results in a more robust inflammatory response and a higher overall pulmonary morbidity in infants with AIDS. PCP treatment in HIV-infected infants warrants more aggressive anti-inflammatory therapy than may be needed in the treatment of PCP in infants with PID.