Original articlePatterns of morbidity and mortality in AIDS patients on Pneumocystis carinii prophylaxis who died during hospital admission: A report of 50 diseased patients

Background: Since the introduction of prophylaxis against Pneumocystis carinii pneumonia (PCP) the pattern of illnesses related to AIDS has changed. PCP prophylaxis may delay the first AIDS-defining illness (ADI) and shifts the clinical manifestations of AIDS to illnesses other than PCP. Methods: Morbidity and mortality patterns were studied of the first 50 diseased HIV-infected patients who died during hospital admission since the inroduction of PCP prophylaxis. Results: The survival of patients after the diagnosis of AIDS in all patients was 13 months, with no difference in survival between patients who were on zidovudine for more than 6 months before the diagnosis of AIDS and those who were not on zidovudine. PCP was seen in 10 patients as the first ADI who were unaware of being HIV-infected and two during the course of their disease due to inappropriate use of prophylaxis. None of the 50 patients died from PCP. Twenty-five patients suffered from complications of the central nervous system (CNS) and these were the major immediate cause of death. Conclusions: Our findings show that due to the use of PCP prophylaxis the incidence of PCP is low, but that PCP is still a common disease in patients unaware of their HIV infection. On the other hand, our findings suggest that CNS disease is the major immediate cause of death in patients on PCP prophylaxis.