Pneumocystis Carinii (Pneumocystis Jiroveci) Pneumonia (PCP)

Once the top killer of people with HIV, pneumocystis carinii is now treatable and preventable. (Scientists now call it pneumocystis jiroveci.) Without treatment, more than 85% of the people with HIV would sooner or later get pneumocystis.

Anyone whose CD4 cell count is below 200 should take anti-PCP drugs. Strong antiretroviral drug therapy helps keep CD4 counts from dropping.

PCP is still common in people who have been infected with HIV for a long time before treatment. Between 30% and 40% of people with HIV, develop PCP, if they delay treatment until their CD4 cell counts are at or near 50.

Symptoms

Difficulty breathing, fever and a dry cough are the first signs of PCP. When these symptoms occur, the person should see a doctor right away. Pneumocystis usually attacks the lungs. It causes a form of pneumonia. Most people who get PCP grow weaker, lose a lot of weight and are likely to get PCP again in the future.

Causes

PCP is caused by a fungus. A healthy immune system can control the fungus. Adults with weakened immune systems or children canÕt fight the fungus as well and get a form of pneumonia. People with a CD4 cell count less than 200 have the great risk of developing PCP. People with higher CD4 counts who also have other infections are also at risk of getting PCP.

Risk Factors

Highly active antiretroviral therapy (HAART) is the best way to prevent PCP. People who have fewer than 200 CD4 cells should take the drugs used to treat PCP. This will prevent PCP from developing. Once CD4 cell counts rise above 200 and stay there for three months, itÕs usually safe to stop taking anti-PCP drugs. These drugs arenÕt costly and have only mild side effects. Some researchers think the drugs should be continued until the CD4 cell count reaches 300.

(Never stop taking any drug a doctor has prescribed without talking with the doctor first.)

Treatment

The drugs now used to treat PCP include:

• TMP/SMX (Bactrim or Septra) is the most effective anti-PCP drug. It combines two antibiotics: trimethoprim (TMP) and sulfamethoxazole (SMX). It is not costly. It is given as a pill taken daily. The ÒSMXÓ of the blend is a sulfa drug. Nearly half the people who take it get an allergic reaction. This is usually a skin rash, sometimes with a fever. The dosage of TMP/SMX can be cut back to three pills a week to reduce the allergy problems. Sometimes a process is used to build up a tolerance for the sulfa drug.
• Dapsone is like TMP/SMX and appears to be almost as effective. It is taken as a daily pill and isn't costly. Dapsone causes fewer allergic reactions than TMP/SMX.
• Pentamidine (NebuPent, Pentam, Pentacarinat) is a drug that is inhaled in a fine mist. This means a monthly visit to a clinic with a nebulizer (the machine that makes the mist). The mist is inhaled for 30 to 45 minutes. It is more expensive than TMP/SMX or Dapsone. If PCP is active, pentamidine can be injected into a vein. People using aerosol pentamidine get PCP more often than people taking the antibiotic pills do.
• Atovaquone (Mepron) is used in people with mild or moderate cases of PCP who cannot take TMP/SMX or pentamidine.