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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Pulmonary Manifestations of HIV Infection in the Era of Highly Active Antiretroviral Therapy [Wolff AJ, O'Donnell AE CHEST 2001;120:1888] This is a report from Georgetown University comparing rates of PCP and bacterial pneumonia in the pre-HAART (1993-95) and the HAART (1997-2000) eras. As expected, HAART protected against PCP (OR0.37) in a CD4 cell dependent manner, but patients receiving HAART were at increased risk for bacterial pneumonia (OR2.4). Prior PCP predisposed to bacterial pneumonia (OR2.4).

Pulmonary Infections
Pre-HAART Era:
1993-95 		HAART Era:
1997-2000
No patients 204 51
CD4 (mean) 71/mm3 137/mm3
Prior PCP 74% 17%
PCP 74 (36%) 9 (18%)
Bacterial pneumonia 59 (29%) 24 (47%)

Comment: The surprise here is the increased risk for bacterial pneumonia in patients receiving HAART despite the higher mean CD4 cell count. This is in contrast to the analysis of patients in the Moore Clinic [Am J Respir Crit Care Med 2000;162:64]. These differences do not make sense and are attributed by the authors to the possibility of selection bias due to limiting the patient's review to those referred to a pulmonary consulting service.
posted 1/7/2002





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