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Management and Outcome Patterns for Adult Pneumocystis carinii Pneumonia, 1985 to 1995^*

Comparison of HIV-Associated Cases to Other Immunocompromised States

^* From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Correspondence to: Henry Koziel, MD, Division of Pulmonary and Critical Care Medicine, Palmer Building, Room 108, Beth Israel Deaconess Medical Center, One Deaconess Rd, Boston, MA 02215; e-mail: hkoziel{at}caregroup.harvard.edu

Study objectives: Encompassing periods preceding and following major advances in the diagnosis and management of HIV-related Pneumocystis carinii pneumonia (PCP), the purpose of this study was to determine whether management and outcome patterns of non-HIV PCP parallel the management and outcomes of AIDS-related PCP.

Design: Retrospective review of medical records.

Setting: A 375-bed tertiary-care urban teaching hospital and referral center.

Patients: All adult patients with morphologically confirmed PCP from 1985 to 1995.

Measurements and results: From 1985 to 1995, 638 confirmed cases of PCP were identified, including 605 cases in 442 HIV-positive persons (HIV + PCP), and 33 cases in 33 non-HIV patients (non-HIV PCP). For HIV + PCP cases, a peak of 104 cases occurred in 1987, with a gradual decline to 23 in 1995. The proportion of cases requiring hospitalization declined from a peak of 91.6% in 1987 to a low of 51.6% in 1992. ICU admission was required for 6.3 to 8.2%, and mechanical ventilation for 4.7 to 5.7%. Overall mortality improved from 11.7 to 6.6%, although mortality for intubated patients remained at 50 to 60%. For the non-HIV PCP cases, 97% occurred from 1989 to 1995 with similar annual frequency, 97% required hospitalization, 69% required ICU admission, and 66% required intubation. Overall mortality was 39%, and mortality for intubated patients was 59%.

Conclusions: Despite major advances in diagnosis and management, PCP remains a significant problem in non-HIV-infected patients, and respiratory failure remains associated with a high mortality rate for patients with both HIV + PCP and non-HIV PCP.

Key Words: AIDS • HIV • immunosuppression • mechanical ventilation • mortality • Pneumocystis carinii pneumonia

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