HIV Digest	HIV Digest Archive

Since the advent of highly active antiretroviral therapy (HAART), reported incidence of opportunistic infections (OI) in HIV patients has markedly decreased. And yet, investigators found large numbers of Pneumocystis carinii Pneumonia (PCP) cases at Chicago's Cook County Hospital, a medical facility serving a mostly poor and indigent population. To better understand this patient group, researchers performed a retrospective chart review of 104 pathologically proven cases of PCP from January 1998 to June 2001.

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The doctors checked inpatient and outpatient medical and laboratory records for demographics, HIV risk factors, substance abuse on hospital admission, outcome and post-hospital discharge data.

Most patients diagnosed with PCP were African-American, male, active substance abusers who reported heterosexual contact as the most common HIV risk factor. Fifty percent of patients knew their HIV status. Forty-eight percent of patients, including 25 percent of patients who did not know their HIV status, had contact with the Cook County medical system in the 12 months prior to the study. Less than five percent were on HAART therapy or PCP prophylaxis prior to admission. Only 16 patients had a history of a previous OI. Most patients were admitted from the emergency room. Fourteen percent of patients died in the hospital.

Of the 58 HAART patients, 60 percent had adherence problems with the therapy. Continued substance abuse was documented in 39 percent. Factors that predicted failure to achieve a viral load less than 1,000 copies per milliliter in the year post discharge, the researchers found, were continued active drug use and a high viral load on presentation. "Our study shows that patients are still being admitted with PCP in the HAART era. Active substance abuse and failure to recognize HIV status contributed heavily to this late presentation of HIV disease. An aggressive approach toward HIV identification and substance abuse treatment may decrease admissions to the hospital for PCP and improve response to HAART therapy," study authors wrote.

Editor's Note: from AIDS Patient Care and STDs