EARLY DETECTION OF PNEUMOCYSTIS CARINII IN AIDS

该项目的长期目标是建立 标准肺功能试验(PFT)在早期发现中的应用 年卡氏肺孢子虫肺炎的调查与处理 HIV阳性患者。由于HIV阳性患者的发病率 增加，对非侵入性和筛查测试的需求增加 卡氏肺孢子虫(P.carinii)早期诊断 常见的对此类患者的影响也在增加。这是我们的 假设PFT，这是一种容易进行和非侵入性的， 在无症状的HIV阳性患者中将允许早期 卡氏肺孢子虫亚临床感染的检测。早期干预 我们相信这将会改善治疗 应答率、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 可疑的治疗时长和治疗效果将受到指导 并通过顺序PFT反映。 我们估计，在接下来的3年里，50,000名艾滋病毒阳性者 患者将生活在我们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社区。 文献中的预测表明，至少有1万人 这些人会患上获得性虚弱综合症 (艾滋病)发生6,000例卡氏肺原虫肺炎 这三年的间隔。媒体的报道和“触角伸得很远” 我们可能会遇到一千或更多的艾滋病病毒 阳性者和数百名卡氏肺炎杆菌。 在五年的时间里，我们将前瞻性地研究720名艾滋病毒 连续PFT阳性的患者。患者将根据以下条件进行分组 关于呼吸道症状，并输入以下方案之一： PFT异常且均有症状的无症状患者 患者将接受支气管肺泡灌洗(BAL)以确定 卡氏肺孢子虫生物体的鉴定；无症状患者 在BAL上发现感染卡氏肺孢子虫的人将被随机 被分配给喷雾剂的；被感染的 有症状的患者将被随机分配到传统的 使用或不使用喷雾剂喷雾剂的肠外治疗； 其余患者，包括BAL结果为阴性的患者和 正常的PFT之后是连续的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.