Fact Sheet Number 511
PCP (Pneumocystis Pneumonia)
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PrintPneumocystis carinii pneumonia (PCP or pneumocystis) is the most
common opportunistic infection in people with HIV. Without treatment,
over 85% of people with HIV would eventually develop PCP. It
has been the major killer of people with HIV. However, PCP is
now almost entirely preventable and treatable.
The infectious agent, Pneumocystis carinii, is a fungus that
is in almost everyone’s body. A healthy immune system can control
PCP. A weakened immune system, however, allows the bug to become
active. Pneumocystis carinii almost always affects the lungs,
causing a form of pneumonia. People with CD4
cell counts under 200 have the highest risk of developing
PCP. People with counts under 300 who have already had another
opportunistic infection are also at risk. Most people who get
PCP become much weaker, lose a lot of weight, and are likely to
get PCP again.
The first signs of PCP are difficulty breathing, fever, and
a dry cough. Anyone with these symptoms should see a doctor immediately.
However, everyone with CD4 counts below 300 should discuss PCP
prevention with their doctor, before they experience any symptoms.
For many years, antibiotics were used to prevent PCP in cancer
patients with weakened immune systems. It was not until 1985
that a small study showed that these drugs would also prevent
PCP in people with AIDS.
The success in preventing and treating PCP is dramatic:
- PCP was the first AIDS-defining diagnosis for only 32% of
cases in 1993, compared to 63% in 1987;
- PCP was the cause of death for 14% of people with AIDS in
1993, compared to 32% in 1987;
- Between 1991 and 1997, there was a 36% drop in the number
of PCP cases in the US. Since people started using combination
antiviral therapy, the number of cases has dropped even further.
The drugs used to treat PCP include TMP/SMX, dapsone, pentamidine,
and atovaquone.
- TMP/SMX (Bactrim® or Septra®) is the most
effective anti-PCP drug. It’s a combination of two antibiotics:
trimethoprim (TMP) and sulfamethoxazole (SMX).
- Dapsone is similar to TMP/SMX. Dapsone seems to be
almost as effective as TMP/SMX against PCP.
- Pentamidine (NebuPent®, Pentam®, Pentacarinat®)
is a drug that is inhaled in an aerosol form to prevent PCP.
Pentamidine is also used intravenously (IV) to treat active
PCP.
- Atovaquone (Mepron®) is a drug used in people
with mild or moderate cases of PCP who can not take TMP/SMX or
pentamidine.
The drugs used to treat PCP can also be used to prevent the disease.
People who have less than 200 T-cells should take medications
to prevent PCP.
Combination antiviral therapy can make your T-cell count go
up. If it goes over 200 and stays there for 3 to 6 months, it
might be safe to stop taking PCP medications. Be sure to talk
with your doctor before you stop taking any of your prescribed
medications.
BEST?
Bactrim or Septra (TMP/SMX) is the most effective drug against
PCP. It is also inexpensive, costing only about $10 per month.
It is taken in pill form, not more than one pill daily.
However, the “SMX” part is a sulfa drug and almost
half of the people who take it have an allergic reaction. This
usually is a skin rash, sometimes a fever. Allergic reactions
can be overcome using a desensitization procedure. Patients start
with a very small amount of the drug and take increasing amounts
until they can tolerate the full dose.
Dapsone causes fewer allergic reactions than TMP/SMX. It is
also fairly inexpensive – about $30 per month. It also is taken
as a pill and, like Bactrim or Septra, not more than one pill
daily.
Pentamidine involves a monthly visit to a clinic with a nebulizer,
the machine that produces a very fine mist of the drug. The mist
is inhaled directly into the lungs. The procedure takes about
30 to 45 minutes. You pay for the drug plus the clinic costs,
between $120 and $250 per month. Patients using aerosol pentamidine
get PCP more often than people taking the antibiotic pills.
New research has looked at taking even fewer pills to prevent
PCP. Cutting back from one pill a day to three pills a week reduces
the allergy problems of Bactrim and Septra, and seems to work
just as well.
PCP, which was the number one killer of people with HIV, is almost
totally treatable – and preventable with inexpensive drugs that
are easy to take. If your T-cell (CD4) count is below 300, talk
to your doctor about taking drugs to prevent PCP. Everyone
whose T-cell count is below 200 should be taking anti-PCP medication.
Revised June 24, 1999
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