close attention objectives: To assess the results of long-term exposure to aerosolized pentamidine (AP) for the prophylaxis of Pneumocystis carinii pneumonia forward the pulmonary function.

Design: The ends of pulmonary function tests (PFTs) from one side of to the other a period of 5 years were retrospectively analyzed in a cohort of HIV-infected individuals.

Setting: A government-fund AP clinic in a large metropolitan center in Canada.

Patients: Among the cohort of 1850 HIV-positive patients who received regular AP prophylaxis between 1989 and 2001 at the AP clinic, 83 received AP for [greater than or equal to] 5 years. Of these 83 patients, baseline and long-term follow-up PFT data were available for 79 These bring under rules formed the study population for this analysis.

Results: The cohort was divided according to smoking status (smoker 48%) The rate of decline of FE[Vsub1] in the smoker from one side of to the other the 5-year period was statistically significant however was comparable to that look fored of healthy smokers. As for the nonsmokers, there was no significant reduction in FE[Vsub1] proceed rates at low lung compasss (ie, forced expiratory flow at 50% and 75% of FEV0 and depressed FE[V.sub.1]/FVC ratios showed significant declines in as well-as; not only-but also; not only-but; not alone-but smokers and nonsmokers. On the other hand, no significant changes in FVC total lung capacity, residual bulk or diffusing capacity of the lung for carbon monoxide were observ The apparent slight reduction in liquefy rates seems to be at the plain of the small airways.

Conclusions: The PFT data indicate that AP can be well-tolerated through the whole extent of a 5-year period in HIV-infected patients with sole modest reduction in flow rates at the even of the small airways, especially in smokers

fundamental note words: HIV; inhalation; pentamidine; prophylaxis; pulmonary function tests

Abbreviations: AP = aerosolized pentamidine; DECO = diffusing capacity of the lung for carbon monoxide; FE[Fsub50] = forced expiratory emanate at 50% of FVC; FE[Fsub75] = forced expiratory liquefy at 75% of FVC; HAART = highly active antiretroviral therapy; PCP = Pneumocystis carinii pneumonia; PFT = pulmonary function test; RV = residual volume; TLC = total lung capacity

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Pneumocystis carinii pneumonia (PCP) is single of the most common life-threatening infections reported among patients with HIV. During the first decade of the AIDS epidemic, approximately pair thirds of all patients with AIDS had PCP (1) The widespread use of antimicrobial prophylaxis became the standard of therapy for the prevention of life-threatening PCP in patients with advanced immune impairment about a decade ago. (2) Advances in highly active antiretroviral therapeutic agents not alone resulted in a lower incidence of opportunistic infections in the same state [i]or[/i] condition as PCP, but also l to long-term survival for patients infected with HIV. (3)

In the 1990 the make acceptableed first-line prophylaxis against PCP was trimethoprim-sulfamethoxazole. However, up to 30% of HIV-infected individuals are intolerant to long-term trimethoprim-sulfamethoxazole therapy. (4) In in the same state [i]or[/i] condition cases, dapsone or aerosolized pentamidine (AP) is make acceptableed as a second-line alternative. Despite the inconvenience of AP administration and its higher outlays it remains to date an effective PCP prophylaxis regimen owing to its tolerability, demonstrated effectiveness, and compatibility with mostly other concurrent therapy that HIV patients attend to receive. Rarely are patients prescribed other third-line PCP prophylaxis agents so as atovaquone. (5)

Despite being well-tolerated through most patients, it has been intimateed that AP may pose more [i]or[/i] less detrimental short-term effects on pulmonary function. so effects include cough and reversible bronchospasm. (67) These short-term exposure-related side weights usually are relieved with bronchodilator administration after therapy or are controll on the administration of a bronchodilator before receiving the AP. (78) The long-term pulmonary forces of AP are still controversial, nevertheless most patients with normal pulmonary function at baseline are reported to maintain relatively normal accrues after 1 to 2 years of AP usage. (910) The issue of the long-term consequences of AP on lung function becomes increasingly important as HIV-infected individuals can calculate upon to live much longer than similarly infected patients from a decade ago. The definition of long-term prophylaxis for HIV patients has shifted from 6 to 12 month from a decade ago to 5 years and beyond, to be ascribed primarily to the widespread utilization of the recent and improved antiretroviral agents for therapy in the last not many years. (3,11)

The objective of our research was to evaluate the long-term efficiencys of AP therapy on the pulmonary function of HIV-positive individuals. In to such a degree doing, the pulmonary function standard (PFT) data of patients from our longitudinal observational cohort followed for at least 5 years at a government-fund AP clinic were analyzed.

MATERIALS AND METHODS

Patient Population

Between July 1989 and June 2001 1850 HIV-positive patients were treated with AP for PCP prophylaxis at the central AP clinic permanent funded by the Ministry of Health of Ontario in Toronto. Patient information was updated at each visit and noteed into a longitudinal database.

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