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April 24, 1995

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

Author Affiliations

Belgium (N. Clumeck); Saint-Pierre Hospital, Brussels. Denmark (J. O. Nielsen); Hvidovre Hospital; Frederiksberg Hospital; Rigshospitalet, Copenhagen. Finland (A. Ranki); University Central Hospital, Helsinki. France (C. Katlama); Hôpital de la Pitié-Salpétrière, Paris. Germany (M. Dietrich); Bernhardtitut, Hamburg; Medizinische Poliklinik, Munich. Greece (J. Kosmidis); Athens General Hospital; First IKA Hospital, Athens. Hungary (D. Banhegyi): Postgraduate Medical School, Budapest. Ireland (F. Mulcahy): St James's Hospital, Dublin. Israel (I. Yust): Ichilov Hospital, Tel Aviv; Rambam Medical Center, Haifa; Kaplan Hospital, Rehovot; Hadassah University Hospital, Jerusalem. Italy (S. Vella, A. Chiesi): Istituto Superiore di Sanita, Rome: F. Ancarani, G. Scalise, Università di Ancona; A. Bertaggia, E. Francavilla, Ospedale Civile, Padua; Milan; Ospedale Infermi Rimini; Ospedale Casa del Sole, Palermo; Ospedale Civile, Vicenza; OO.RR. di Bergami; Ospedale Infermi Faenza; Ospedale Riuniti, Parma; Ospedale Niguarda cà Granda, Milan; Ospedale Amedeo di Savoia, Turin; Milan; La Spezia; Patologia Medica Università, Catania; Università Cattolica del Sacro Cuore, Rome; Università di Sassari; Policlinico Monteluce, Perugia; Ospedale Galliera, Genoa; Ospedale S. Maria delle Croci, Ravenna; Ospedale Maggiore, Novara; Ospedale S. Maria Maddalena, Trieste; Ospedale Amedeo di Savoia, Turin. Luxembourg (R. Hemmer): Centre Hospitalier, Luxembourg. The Netherlands (S. Danner); Academisch Ziekenhuis bij de Universitet van Amsterdam. Portugal (F. Antunes): Hospital Santa Maria; Hospital Curry Cabral, Lisbon. Spain (J. González-Lahoz); Instituto Carlos III, Madrid; Hospital Germans Trias i Pujol, Barcelona; J. Miró, Hospital Clinic I Provincial, Barcelona; Sweden (P. Pehrson): Karolinska Institutet, Stockholm. Switzerland (R. Lüthy); Swiss HIV Cohort Study, Zurich; Centre Hospitalier Universitaire Vaudois, Lausanne; Hospital Cantonal Universitaire de Geneve, Geneva. United Kingdom (A. Johnson); UCL Medical School; St Stephen's Clinic, Chelsea and Westminster Hospital; St Mary's Hospital, London

From Hvidovre (Denmark) Hospital, University of Copenhagen (Drs Lundgren and Pedersen); St Stephen's Clinic, London, England (Dr Barton); Hôpital de la Pitié-Salpétière, Paris, France (Dr Katlama); Swiss HIV Cohort Study, Zurich, Switzerland (Dr Ledergerber); CIC Health Institute Carlos III, Madrid, Spain (Dr González-Lahoz); Saint Bartholomew's Hospital, London (Dr Pinching); Hospital Curry Cabral, Lisbon, Portugal (Dr Proenca); Centre Hospitalier, Luxembourg (Dr Hemmer); and University College Medical School, London (Dr Phillips).

Arch Intern Med. 1995;155(8):822-828. doi:10.1001/archinte.1995.00430080056008

Background:  Factors associated with improved survival over time for patients with the acquired immunodeficiency syndrome (AIDS) who have Pneumocystis carinii pneumonia at diagnosis are not clearly defined.

Methods:  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.

Results:  Patients in whom AIDS and P carinii pneumonia had been diagnosed before 1988 had a poorer 3-month (ie, short-term) survival, whereas the survival 1 and 2 years after P carinii 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 P carinii pneumonia episode, both zidovudine and secondary prophylaxis for P carinii 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.

Conclusions:  Survival after an episode of P carinii pneumonia has improved within recent years. Increased awareness of early symptoms of P carinii 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 P carinii 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)