title: Aerosolized pentamidine prophylaxis against AIDS-related Pneumocystis carinii pneumonia and its short- and long-term effects on pulmonary function in the Japanese.
abstract: We evaluated the incidence of prophylaxis failure with aerosolized pentamidine (AP) for Pneumocystis carinii pneumonia (PCP) in Japanese patients with human immunodeficiency virus (HIV) infection, and we examined the short- and long-term effects of AP on pulmonary function. The patients inhaled 300 mg of pentamidine by ultrasonic nebulizer, after the inhalation of procaterol (80 micrograms), every 4 weeks. PCP developed in 2 of 16 patients receiving primary prophylaxis with AP, and in 4 of 13 patients with secondary prophylaxis. The CD4(+) T-lymphocyte count was very low in the patients with prophylaxis failure. The chest radiographic presentations were atypical in 4 of the 6 patients with prophylaxis failure. There were no significant changes in the vital capacity (VC), VC/predictive VC (%VC), forced expiratory volume in 1 s (FEV(1.0)), FEV(1.0)/forced vital capacity (FEV(1.0)%), and maximum expiratory flow rate at 25% of vital capacity (MEF(25))/height comparing values before and after initial AP treatment. However, a reduction of oxygen saturation (SpO(2)) of over 3% was noted in 4 patients during the initial AP administration. In 9 patients receiving AP prophylaxis for more than 36 months, we compared the pulmonary function parameters between the baseline and final observations (mean, 52.7 months). There were no changes in VC, %VC, FEV(1.0,) FEV(1.0)%, and SpO(2), but there was a statistically significant decline in MEF(25)/height after long-term AP treatment. We concluded that the incidence of prophylaxis failure with AP for PCP in Japanese patients was similar to that in Western patients, and that long-term AP treatment affected MEF(25)/height in spite of the safe pulmonary effects in short-term AP inhalation.
authors.affiliation: Second Department of Internal Medicine, Nara Medical University, Japan. mkonishi@naramed-u.ac.jp
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Konishi
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yoshimoto
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Uno
authors.forename: Kei
authors.initials: K
authors.lastname: Kasahara
authors.forename: Koichi
authors.initials: K
authors.lastname: Murakawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Maeda
authors.forename: Keiichi
authors.initials: K
authors.lastname: Mikasa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Narita
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D000328:Adult; D000336:Aerosols; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010419:Pentamidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011020:Pneumonia, Pneumocystis / Q000276:immunology / Q000517:prevention & control*
chemical_list: D000336:Aerosols; D010419:Pentamidine