EARLY DETECTION OF PNEUMOCYSTIS CARINII IN AIDS

该项目的长期目标是建立 标准肺功能测试（PFT）在早期检测 卡氏肺孢子虫肺炎的诊断和治疗 艾滋病毒阳性患者。 由于艾滋病毒阳性患者的发病率 增加，需要一个非侵入性和筛选测试， 早期诊断卡氏肺孢子虫（P. carinii）， 这类患者的发病率也会增加。 是我们 假设PFT，这是很容易执行和非侵入性， 在无症状的艾滋病毒阳性患者中， 检测亚临床卡氏肺孢子虫感染。 早期干预 我们相信这将改善治疗 反应率、长期发病率和死亡率。 此外，在接受抗肺孢子虫治疗的患者中，我们 将指导可疑治疗长度和治疗效果 并由顺序PFT反映。 我们估计，在未来3年内， 病人将存在于我们的艾滋病中心的集水区， 包括88万成年男性和一个庞大的同性恋群体。 文献预测表明，至少有10，000名 这些人会患上后天免疫缺陷综合症 （艾滋病），6,000例卡氏肺孢子虫肺炎发生在 这三年的间隔。 随着媒体的报道和“外展” 我们预计会遇到1000或更多的艾滋病毒 阳性个体和数百例卡氏肺孢子虫肺炎。 在五年的时间里，我们将对720名艾滋病毒感染者进行前瞻性研究。 连续性PFT的阳性患者。 患者将根据 呼吸道症状，并输入以下协议之一： PFT异常的无症状患者和所有有症状患者 患者将接受支气管肺泡灌洗（BAL）， 卡氏肺孢子虫的鉴定;无症状患者 在BAL上发现感染卡氏肺孢子虫的患者将随机 分配到喷他脒雾化方案;感染 有症状的患者将被随机分配到传统的 使用或不使用雾化喷他脒的胃肠外治疗; 其余患者，包括BAL结果阴性的患者， 正常PFT之后将进行连续PFT。

This project's long term goal is to establish the usefulness of standard Pulmonary Function Testing (PFT) in the early detection and management of Pneumocystis carinii (P. carinii) pneumonia in HIV positive patients. As the incidence of HIV positive patients increases, the need for a non-invasive and screening test for the early diagnosis of Pneumocystis carinii (P. carinii) which commonly affects such patients also increases. It is our hypothesis that PFT, which is easily performed and non-invasive, in asymptomatic HIV positive patients will allow for early detection of sub-clinical P. carinii infections. Early intervention can thus be instituted which we believe will improve treatment response rates, long term morbidity and mortality rates. Furthermore, in patients receiving anti-Pneumocystis therapy, we suspect length of therapy and therapeutic efficacy will be guided and reflected by sequential PFT. We estimate that over the next 3 years 50,000 HIV positive patients will exist in our AIDS Center's catchment area which includes 880,000 adult males and a large homosexual community. Projections from the literature suggest that at least 10,000 of these individuals will develop Acquired Deficiency Syndrome (AIDS) with 6,000 cases of P. carinii pneumonia occurring over this 3 year interval. With media coverage and "out-reach" programs we can expect to encounter a thousand or more HIV positive individuals and several hundred P. carinii pneumonias. Over a five year period we will prospectively study 720 HIV positive patients with serial PFT. Patients will be grouped based on respiratory symptoms and enter one of the following protocols: Asymptomatic patients with abnormal PFT and all symptomatic patients will undergo bronchoalveolar lavage (BAL) for definitive identification of P. carinii organisms; asymptomatic patients found to be infected with P. carinii on BAL will be randomly assigned to an aerosolized Pentamidine protocol; infected symptomatic patients will be randomly assigned to conventional parenteral therapy with or without aerosolized Pentamidine; the remaining patients, including those with negative BAL results and normal PFT, will be followed with serial PFT.