Pulmonary tolerance of prophylactic aerosolized pentamidine in human immunodeficiency virus-infected patients (original) (raw)
Related papers
The American journal of …, 1993
PURPOSE To evaluate the long-term effkacy and safety of inhaled pentamidine as primary prophylaxis against Pneumocystis ca.riG pneumonia (PCP) in patients infected with human immunodeficiency virus (HIV). PATIENTS Two hundred thirty-two HIV-infected patients with a CD4 cell count below 20% of the total lymphocyte couut were given aerosolized pen-0 once every 4 weeks for more than 3 months. Pentamidine aerosols were administered at the hospital under medical supervision. Prevention of bronchospasm was carried out us.& inhaled salbutamol. RESULTS Mean duration of prophylaxis was 16.9 months. Eleven patienta (4.7%; [95% confidence interval 2 % to 7.4 % 1) developed PCP. Probability to remain free of PCP is 96.6% at 12 months, 94% at 18 months, and 88% at 24 months. Mean delay between the ouset of the prophylaxis and the occurrence of PCP for the 11 patienta was 12.9 months (range: 4 to 26 months). No major side effect was observed, and minor side effects (cough, acute dyspnea) were infrequent. CONCLUBION: The efficacy and tolerance of aerosolkd pentamidiue as shown in our study support its use as primary prophylaxis against I? cariaii in HIV-infected patients. From the Department of Chest Medicine (SP. JMG, A Belguendouz, JL). Deoarbnent of Internal Madiclne (D Salmon, FR. ET. MER. D Ward. D&e& A Boissonnas). Department of Dermatology (JD. JPM, IG). and Hemophilia Center (JMB. DB. YS). Hopital Cochin,
Klinische Wochenschrift, 1990
We evaluated 43 AIDS patients on prophylaxis with aerosol pentamidine (60 mg biweekly) after Pneumocystis carinii pneumonia (PCP). The effects of patients' inhalation compliance and of laboratory data during the initial PCP on subsequent PCP relapses were assessed. After a median of 8 months (range, 2-21.5 months) on pentamidine prophylaxis, 13 patients suffered a PCP relapse. Six of them had missed at least one inhalation within the last month before the relapse. Two of these six relapses were fatal. The relapse occurrence was significantly associated with the percentage of missed inhalations. Additional significant associations were found between relapses, low levels of T4 lymphocytes, and elevated serum lactate dehydrogenase during the initial PCP episode (29 patients). Mean levels of T4 lymphocytes were 27/mm 3 and 47/ram 3 in patients with and without subsequent relapses, mean levels of lactate dehydrogenase were 692 U/L and 605 U/L, respectively. Multivariate Cox regression did not reveal further differences between patients with and without relapses. The increased relapse risk associated with poor inhalation compliance stresses the need for appropriate guidance and motivation of the patients.
Clinical Infectious Diseases, 1997
The incidence and severity of adverse drug reactions (ADRs) in human immunodeficiency virusinfected persons receiving intravenous pentamidine for Pneumocystis carinii pneumonia during a 5-year period were reviewed retrospectively. Predisposing risk factors for ADRs were identified. ADRs were included if they occurred during or within 1 week following the discontinuation of pentamidine treatment. Nephrotoxicity, dysglycemia, hepatotoxicity, hyperkalemia, and hyperamylasemia accounted for 80% of ADRs (n = 174) that occurred in 76 (71.7%) of 106 patients during 84 treatment courses of pentamidine. A significant relationship between hypoglycemia and nephrotoxicity was observed (P = .002). Four factors were significantly associated with occurrence of an ADR: number of concomitant medications (odds ratio [OR] = 1.36, P = .005), nonwhite ethnicity (OR = 5.00, P = .017), cumulative dosage of pentamidine (OR = 1.03, P = .030), and concurrent use of other nephrotoxic drugs (OR = 2.34, P = .047). Two factors, daily dosage and history of intravenous drug use, approached significance. Knowledge of and avoidance of potential risk factors might allow safer use of pentamidine and reduce the prevalence of ADRs.
American Journal of Respiratory and Critical Care Medicine, 2010
Rationale: Before the introduction of combination antiretroviral (ARV) therapy, patients infected with HIV had an increased prevalence of respiratory symptoms and lung function abnormalities. The prevalence and exact phenotype of pulmonary abnormalities in the current era are unknown. In addition, these abnormalities may be underdiagnosed. Objectives: Our objective was to determine the current burden of respiratory symptoms, pulmonary function abnormalities, and associated risk factors in individuals infected with HIV. Methods: Cross-sectional analysis of 167 participants infected with HIV who underwent pulmonary function testing. Measurements and Main Results: Respiratory symptoms were present in 47.3% of participants and associated with intravenous drug use (odds ratio [OR] 3.64; 95% confidence interval [CI], 1.32-10.046; P 5 0.01). Only 15% had previous pulmonary testing. Pulmonary function abnormalities were common with 64.1% of participants having diffusion impairment and 21% having irreversible airway obstruction. Diffusion impairment was independently associated with ever smoking (OR 2.46; 95% CI, 1.16-5.21; P 5 0.02) and Pneumocystis pneumonia prophylaxis (OR 2.94; 95% CI, 1.10-7.86; P 5 0.01), whereas irreversible airway obstruction was independently associated with pack-years smoked (OR 1.03 per pack-year; 95% CI, 1.01-1.05; P , 0.01), intravenous drug use (OR 2.87; 95% CI, 1.15-7.09; P 5 0.02), and the use of ARV therapy (OR 6.22; 95% CI, 1.19-32.43; P 5 0.03). Conclusions: Respiratory symptoms and pulmonary function abnormalities remain common in individuals infected with HIV. Smoking and intravenous drug use are still important risk factors for pulmonary abnormalities, but ARV may be a novel risk factor for irreversible airway obstruction. Obstructive lung disease is likely underdiagnosed in this population.
Pneumonia in HIV-Infected Patients
Eurasian Journal of Pulmonology, 2016
This author's first-hand experience indicates that these types of pneumonia are often differentiated from each other according to the absence of purulent sputum and the duration of respiratory symptoms (4). The presence of systemic hypotension would be concerning for a fulminant disease process. Predictors of mortality are age, recent drug injection, total bilirubin, serum albumin lower than 3 g/dL, and alveolararterial oxygen gradient greater than or equal to 50 mmHg for Pneumocystis carinii pneumonia (PCP) (5). Our review elucidates the pathogenesis and causative agents of bacterial pneumonia, tuberculosis (TB), nontuberculous mycobacterial (NTM) disease, fungal pneumonia, Pneumocystis pneumonia, viral pneumonia, and parasitic infections. Use of prophylaxis intercalarily to antiretroviral therapy (ART)
Measurement of antiretroviral drugs in the lungs of HIV-infected patients
HIV Therapy, 2010
Aims-Prior studies have shown that HAART is associated with decreased HIV viral load in the lungs. The correlation between antiretroviral exposure in bronchoalveolar lavage (BAL) fluid and virologic response was evaluated in patients starting HAART and enrolled in The AIDS Clinical Trial Group Protocol 723.