Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome

Abstract

Admissions and deaths in a pulmonary medicine ward in Abidjan, Cote d'Ivoire, West Africa, were evaluated over a 6-month period in 1989 with systematic autopsies on all patients who died. Of 473 patients admitted, 38% were HIV-1 seropositive, 4% were HIV-2 seropositive, and 14% reacted to both viruses. A total of 100 patients (21%) died, and deaths were twice as frequent in HIV-seropositive compared with HIV-negative patients. The pathology of 78 autopsies showed that the predominant cause of death in HIV-seropositive patients was disseminated tuberculosis (40%). Cancer was the cause of death in 64% of HIV-negative patients. Pneumocystosis was found in only 9% of HIV-seropositive autopsies. Since Pneumocystis carinii is an uncommon cause of death in this population, prophylaxis for P. carinii pneumonia is not warranted for HIV-infected patients in Africa. In contrast, research on chemoprophylaxis for tuberculosis is urgently required.

PIP: Between January-June 1989, researchers evaluated 473 admissions and 100 deaths at the Pulmonary Medicine Service at the University Hospital in Abidjan, Ivory Coast to determine prevalence of HIV-1 and HIV-2 infections, to look at death rates in relation to HIV status, and to examine the pulmonary pathology associated with these infections compared with deaths in HIV negative patients. HIV-1 seroprevalence was 38%, HIV-2 4%, and dual HIV reactive 14%. The death rate for the entire sample was 21%. It was higher in HIV seropositive patients than HIV seronegative patients (27% vs. 14%; relative risk=1.95 times). HIV seropositive patients regardless of HIV group essentially died from the same diseases: 40% from pulmonary tuberculosis (disseminated nonreactive multibacillary pattern), 34% from nonspecific pneumonia, 8% from Pneumocystis pneumonia, 6% from Kaposi's sarcoma, and 4% from lung cancer. Among only HIV-1 seropositive cases, Pneumocystis carinii was the cause of death in only 95 of cases. The leading causes of death for HIV seronegative patients included lung cancer (64%), nonspecific pneumonia (28%), and pulmonary tuberculosis (4%). Researchers should be pressed to develop more sensitive means to diagnosis tuberculosis as well as prophylaxis against reactivation of tuberculosis among HIV seropositive people in Africa. Since Pneumocystis carinii infection is uncommon among HIV seropositive people in Africa, prophylaxis for it is not needed.