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

Abstract

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