Changes in Survival Over Time After a First Episode of Pneumocystis carinii Pneumonia for European Patients With Acquired Immunodeficiency Syndrome

Abstract

<h3>Background:</h3> Factors associated with improved survival over time for patients with the acquired immunodeficiency syndrome (AIDS) who have<i>Pneumocystis carinii</i>pneumonia at diagnosis are not clearly defined. <h3>Methods:</h3> An inception cohort of 2533 patients with AIDS, diagnosed from 1979 to 1989, from 52 centers in 17 European countries was studied. Survival 3 months and 3 years after diagnosis was estimated by Kaplan-Meier life tables. Independent predictors of survival were analyzed by construction of Cox proportional hazards models. <h3>Results:</h3> Patients in whom AIDS and<i>P carinii</i>pneumonia had been diagnosed before 1988 had a poorer 3-month (ie, short-term) survival, whereas the survival 1 and 2 years after<i>P carinii</i>pneumonia was lower only for patients whose disease was diagnosed before 1987 compared with those with more recent diagnoses. Other variables associated with poorer outcome were greater age, infection via blood transfusion, diagnosis made in south Europe, and coexisting illnesses. After controlling for these prognostic markers in multivariate analysis, improvement in survival over time was still evident. For patients who survived the<i>P carinii</i>pneumonia episode, both zidovudine and secondary prophylaxis for<i>P carinii</i>pneumonia initiated around the time of diagnosis were associated with improved survival, and, after controlling for these treatment variables, no statistically significant improvement in survival over time was observed. <h3>Conclusions:</h3> Survival after an episode of<i>P carinii</i>pneumonia has improved within recent years. Increased awareness of early symptoms of<i>P carinii</i>pneumonia and better treatment of the pneumonia may have led to improvement in short-term survival over time, whereas the introduction of zidovudine and increased use of secondary<i>P carinii</i>pneumonia prophylaxis may have resulted in the recent increase in survival 1 and 2 years after the diagnosis. However, 3-year survival remained unchanged over time, implying that the underlying human immunodeficiency virus infection and other complications are not effectively controlled. (Arch Intern Med. 1995;155:822-828)