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Older HIV patients have greater PCP mortality
WESTPORT, CT (Reuters Health) - Although care has improved in recent years, patients with HIV-related Pneumocystis carinii pneumonia (PCP) who are 50 years or older have higher rates of in-hospital mortality, researchers report in the October issue of the Journal of General Internal Medicine.
Dr. Charles L. Bennett, now with the VA Chicago Health Care System-Lakeside Division, and colleagues note that in a previous study of such patients in the late 1980s, they established that those 50 years and older were almost twice as likely to die as were younger patients.
To examine how the situation might have changed, the researchers conducted a similar study involving records of 1861 patients who had HIV-related PCP and received in-hospital treatment between 1995 and 1997.
Compared with those under the age of 50, older patients were less likely to have HIV mentioned in their progress notes (70% versus 82%), to have received anti-PCP medication within the first 2 days of hospitalization (86% versus 93%) and to survive hospitalization (82% versus 90%).
However, after allowing for PCP severity and timeliness of therapy, age was not a significant predictor of mortality.
Nevertheless, say the investigators, the new findings are consistent with the previous ones, and although "inpatient PCP mortality has improved by 50% in the past decade, twofold age-related mortality differences persist."
Because physicians tend to perceive AIDS as a younger persons' disease, the researchers call for "continued vigilance for the possibility of HIV and HIV-related PCP" in people of 50 years and older who present with new pulmonary symptoms.
In a comment to Reuters Health, Dr. Bennet stressed that "physicians often did not suspect that the individual might be HIV-infected. Consequently, the appropriate antibiotic, Bactrim, was infrequently initiated in a timely manner and one fifth died."
Although "10% of AIDS patients in the United States are older than 50," he concluded, "they may not be receiving high quality AIDS care."
J Gen Intern Med 2001;16:583-589.
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