title: Prophylaxis for Pneumocystis carinii pneumonia: its impact on the natural history of HIV infection in men with haemophilia.
abstract: It has been suggested that the range of AIDS-defining conditions witnessed in patients with HIV infection has changed since the early years of the HIV epidemic. In this paper we consider the range of AIDS-defining conditions in a cohort of 111 HIV-positive men with haemophilia registered at the Royal Free Hospital Haemophilia Centre. In particular we assess whether the incidence of Pneumocystis carinii pneumonia (PCP) has changed over time. The men were all infected between 1979 and 1985 after treatment with infected blood products and have now been followed prospectively for up to 13 years from HIV seroconversion. By the end of 1992, 44/111 patients had developed AIDS. Of the 44 men, 18 (41%) presented with PCP as their first AIDS-defining condition (ADC), mainly before the initiation of primary prophylaxis in 1989. The remaining 26 patients presented with a range of conditions as their first ADC, but there were no more than four cases in any one disease category. It is estimated that patients suffer from 0.7 further ADCs per year after being diagnosed with AIDS. After taking account of the increased levels of immuno-suppression in the cohort with time, it appears that the incidence of PCP, both as the first ADC or as any ADC, has declined since the introduction of primary prophylaxis for the disease in 1989. However, non-compliance with prophylaxis for PCP appears to have played a major role in the continuing occurrence of PCP since 1988. Improvements in compliance with therapy should result in a further reduction in the incidence of PCP both as a first ADC and as any ADC.
authors.affiliation: Haemophilia Centre and Departments of Public Health and Immunology, Royal Free Hospital School of Medicine, London.
authors.forename: C A
authors.initials: CA
authors.lastname: Sabin
authors.affiliation: Haemophilia Centre and Departments of Public Health and Immunology, Royal Free Hospital School of Medicine, London.
authors.forename: J
authors.initials: J
authors.lastname: Elford
authors.affiliation: Haemophilia Centre and Departments of Public Health and Immunology, Royal Free Hospital School of Medicine, London.
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
authors.affiliation: Haemophilia Centre and Departments of Public Health and Immunology, Royal Free Hospital School of Medicine, London.
authors.forename: G
authors.initials: G
authors.lastname: Janossy
authors.affiliation: Haemophilia Centre and Departments of Public Health and Immunology, Royal Free Hospital School of Medicine, London.
authors.forename: C A
authors.initials: CA
authors.lastname: Lee
keywords: AIDS-defining conditions; HIV; Pneumocystis carinii pneumonia; haemophilia; non-compliance; prophylaxis