Diagnostic and therapeutic technology assessment. Prophylactic treatment for opportunistic infections in HIV-positive patients: aerosolized pentamidine.
The DATTA panelists considered aerosolized pentamidine to be both safe and effective for primary and secondary prophylaxis of PCP. T4 helper cell counts offer guidance as to the best candidates for primary prophylaxis. Patients with a T4 helper cell count of fewer than 200/mm3 are the most appropriate group to receive primary prophylaxis with aerosolized pentamidine. However, T4 helper cell counts are not an exclusive criterion for aerosolized pentamidine prophylaxis. Some DATTA panelists suggested that certain patients, such as those with Kaposi's sarcoma and lymphomas and those with concomitant human T-cell lymphotropic virus type 1 infection, might be considered candidates for aerosolized pentamidine regardless of T4 helper cell counts. There is no current literature to support this, and this opinion is based solely on clinical experience. Perhaps the use of other markers of immune function (beta 2-microglobulin, neopterin) in conjunction with T4 helper cell counts will give a better indication of when to start primary prophylaxis. Aerosolized pentamidine is not the only potential prophylactic regimen for PCP. Other drugs, including pyrimethamine and sulfadoxine, sulfamethoxazole and trimethoprim, and dapsone, are currently being evaluated. Prior diagnosis and therapy for patients with M tuberculosis must occur before initiation of the use of aerosolized pentamidine. This and other appropriate environmental precautions should reduce transmission of M tuberculosis to health care workers and other patients. Whether any prophylactic treatment of an opportunistic infection will prolong survival in HIV-infected individuals has yet to be proved. The assumption is made, however, that a reduction in opportunistic infections should lower mortality and improve the quality of life.
D000574:American Medical Association; D002986:Clinical Trials as Topic; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D009330:Nebulizers and Vaporizers; D009894:Opportunistic Infections / Q000150:complications / Q000517:prevention & control*; D010419:Pentamidine / Q000008:administration & dosage*; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D011292:Premedication; D013673:Technology Assessment, Biomedical; D014481:United States
D010419:Pentamidine