Clinical features of Pneumocystis pneumonia in the acquired immune deficiency syndrome.

The courses of 19 patients with Pneumocystis carinii pneumonia complicating the acquired immune deficiency syndrome (AIDS) were reviewed. Compared with previous reviews of Pneumocystis pneumonia in patients without AIDS, Pneumocystis pneumonia in patients with AIDS often has a more prolonged clinical prodrome, with pulmonary symptoms occurring for an average of 3 wk prior to presentation, and often has a slower response to therapy, with radiographic and blood gas improvement occurring an average of 13 and 6 days, respectively, after initiation of therapy. No patient diagnosed during life died as a result of Pneumocystis infection; however, 5 required repeat courses of therapy, and 7 required repeat lung biopsies during the course of treatment. Serious side effects of trimethoprim-sulfamethoxazole therapy included fever, rash, and leukopenia, and occurred in 12 patients. Aggressive diagnostic and therapeutic measures combined with prolonged therapy are required for a satisfactory outcome in patients with AIDS and Pneumocystis pneumonia.