Patterns of care for and outcomes of Pneumocystis carinii pneumonia among persons with transfusion-acquired AIDS

Abstract

Background: The most common human immunodeficiency virus (HIV)-related cause of death in persons with transfusion-acquired (TA) AIDS has been Pneumocystis carinii pneumonia (PCP). While better treatment for PCP accounts for improved survival among HIV-infected homosexual or bisexual men, the extent to which others have benefitted from these developments is unknown.

Study design and methods: Patterns of PCP care among persons with TA-AIDS, intravenous drug users, and homosexual or bisexual men are compared.

Results: TA-AIDS patients were older (mean, 46 years vs. < 40 for others, p < 0.05), more severely ill (59% had an alveolar-arterial oxygen gradient > 48.5 torr vs. 41% of others, p < 0.05), and less likely to have received PCP prophylaxis (16% of TA-AIDS patients versus 24-41% of others, p < 0.05). PCP care and outcomes also differed: TA-AIDS patients were less than half as likely to have early use of PCP medications (relative odds ratio = 0.45; 95% CI, 70% vs. > 80% for others, p < 0.05), more likely to be intubated (22% vs. 9-13% of others, p < 0.05), and more likely to die in-hospital (26% vs. 13-22% of others, p < 0.05). After controlling for differences in severity of illness, insurance, age, and hospital characteristics, TA-AIDS patients were 45 percent as likely to have early PCP therapy (95% CI, 22%, 91%) as were persons in high-risk groups.

Conclusion: For persons whose only risk factor was transfusion, recognition of the HIV infection and its complications appears to be problematic, which may help explain poorer outcomes in persons with HIV-related PCP.