PCP: Forgotten -- But Not Gone

What is PCP?

PCP (PNEUMOCYSTIS CARINII) is a tiny parasite that infects most people during childhood. Normally, this parasite is dormant, doing no damage. When a weakened immune system cannot control the reproduction of the parasite, the result may be an infection (pneumonia).

Symptoms

Fever, cough (dry or productive) and difficulty breathing are symptoms associated with PCP. A patient may have the feeling that they just can't "shake a cold." A doctor may treat it like bronchitis or sinusitis, which it can resemble (and can occur along with PCP in PWAs). Failure to respond to routine antibiotic therapy for sinusitis after one week is a clue pointing to PCP.

Prevention

PCP pneumonia is still with us and it's still deadly. And it's almost 100% preventable, if prophylaxis (prevention) is initiated if your CD4 counts drop below 200. The drugs used for prevention of PCP are TMP-SMX (Bactrim or Septra), dapsone, and aerosolized pentamidine. Use of prophylaxis tends to lessen the severity of the disease in people who develop PCP despite preventative therapy. ( Note: If your T-cells have fallen below 200 and then go back up as a result of taking medications, ask your doctor about continuing prophylaxis. )

Despite the understanding and availability of medicines for prophylaxis, PCP pneumonia remains the most common opportunistic infection and one of the leading causes of death in people with AIDS.

Treatment

If Bactrim or Septra (TMP-SMX) does not control the infection, or if someone cannot tolerate the medicine because of side effects or allergy, other drugs are available for the treatment of PCP. These include atovaquone (Mepron), IV pentamidine (Pentam), IV trimetrexate, dapsone-trimethoprim (investigational), and clindimycin-primiquine (investigational).

The Newest Drug

The newest drug for the treatment of mild to moderate PCP is GlaxoWellcome's Mepron Suspension, a product of ongoing research. Although Bactrim is the most effective treatment for PCP, many patients cannot tolerate it and need alternative therapy.

Studies have shown equal percentages of patients who take Mepron and those taking Bactrim experience side effects at least once during treatment. Yet, fewer patients who were taking Mepron had to stop treatment because of side effects.

If All Else Fails

NeuTrexin is indicated as an alternative therapy for the treatment of moderate to severe PCP in people who are intolerant of, or not responding to, Bactrim or other medications. In an ACTG study comparing NeuTrexin to Bactrim, a greater percentage of patients stopped taking NeuTrexin due to drug failure yet, only 10% of the patients reported side effects that limited therapy, compared to 29% treated with Bactrim.

US Bioscience, providers of NeuTrexin, are in the process of preparing the drug for broad distribution. NeuTrexin is expected to be commercially available the first week in January. Until then, NeuTrexin will continue to be available under Treatment IND by calling Social and Scientific Systems at 1.800.537.9978.

For information about the testing of new drugs for PCP, call the AIDS Clinical Trials Group (ACTG): 1.800.TRIALS-A (1.800.243.2572)

To find out about studies being conducted at the Nation Institutes of Health (NIH) Clinical Center, call 1-800-AIDS-NIH (1.800.243-7644), Monday through Friday, 12-3 PM EST.

If you have any further questions, please call Women Alive; "Voices With A Message": 1.800.554.4876