Outcome and survival in HIV-infected infants with Pneumocystis carinii pneumonia and respiratory failure.
A retrospective chart review (January 1987-December 1994) of cases of histologically proven Pneumocystis carinii pneumonia (PCP) in 9 infants (ages 1.1-7 months) who had perinatally acquired human immunodeficiency-1 virus (HIV) infection was performed. None of the children was suspected of having HIV or had received PCP prophylaxis. Respiratory failure requiring mechanical ventilation developed in all 9 children. Comparison of survivors (5) with nonsurvivors (4) showed no significant differences in the age of onset, weight for length, hemoglobin level, total protein/albumin, lactic dehydrogenase (LDH), liver function tests, lymphocyte numbers and functions, time on mechanical ventilation, treatment received (including the use of steroids), and other complications occurring during the acute phase of pneumonia. The survivors had significantly higher platelet counts than nonsurvivors (mean 516 K versus 237 K, p = 0.02), a trend toward lower arterial-alveolar (A-a) gradient (mean 415 versus 218, p = 0.07), and earlier use of steroids after the onset of illness (2.5 versus 1 day, p = 0.06). Four of 5 children treated after December 1989 survived compared to 1 of 4 prior to that. Four survivors followed for a median length of 29 months (range 28-32 months) had stable physical and neurocognitive development, improvement in CD4+ T cell counts [mean 27% (range 23-36%), absolute count-mean 1631 (range 1427-1631)] and immunologic functions, and decrease in p24 Ag in 3 of 4. The cellular proviral load measured by DNA quantitative polymerase chain reaction (QC-PCR) decreased (40 K to 17.3 K copies) in one of two patients studied at two time points. PCP continues to be a serious complication of HIV infection in infancy and aggressive preventive approaches seem warranted. In our institution no single factor was responsible for improved survival following PCP after 1989. Four of 5 survivors continued to do well 28-32 months after the acute episode.
Sheikh
S
S
Department of Pediatrics, North Shore University Hospital, Manhasset, New York 10030, USA.
Bakshi
S S
SS
Pahwa
S G
SG
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality* / Q000628:therapy; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D010976:Platelet Count; D011020:Pneumonia, Pneumocystis / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D019562:Viral Load
D000305:Adrenal Cortex Hormones