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[null,null,"This Excel workbook contains the Evidence Map on \nPneumocystic Pneumonia"]
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[null,null,"How this Evidence Map was generated"]
[null,null,"We searched heoro.com in December 2017 with the following field settings:"]
[null,null,"Disease: Pneumonia, Pneumocystis"]
[null,null,"The search identified a total of 66 relevant abstracts published since 1960, which were  segmented with the following standard heoro.com fields:"]
[null,null,null,"Locations - the geographical setting of the study, or, where this is unknown, the authors' location"]
[null,null,null,"Disease - comorbidites, if any"]
[null,null,null,"Interventions - the interventions evaluated, if any"]
[null,null,null,"Study type - the main topic of the study, e.g. assessing costs, mortality, efficacy or economic models"]
[null,null,null,"Study methodology - the type of study that was conducted, e.g. clinical trial, observational, systematic review"]
[null,null,null,"Subpopulation - whether the study assessed a specific sub-group of individuals"]
[null,null,"We also categorised the diagnostic tools used"]
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[null,null,"In addition the following publication date segmentations are used:"]
[null,null,null,"1960 to 1990, 1991 to 1995, 1996 to 1999, 2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2017"]
[]
[null,null,"All data in this Evidence Map is taken from the heoro.com database"]
[]
[null,null,"Details of the PubMed search strategy used to populate the heoro.com database can be found here."]
[]
[null,null,"Contact us:"]
[null,null,"Address: Crystallise Ltd. Unit 21, Thames Enterpise Centre, Thames Industrial Park, East Tilbury, Essex, UK RM18 8RH"]
[null,null,"Tel: +44 (0)1375 488020"]
[null,null,"Email: alison.martin@crystallise.com"]

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[{"$f":"COUNT(A2:A988)","v":66},"Full citation","DOI","Authors","Title","Abstract","Citation","Locations","Year","Diseases","Interventions","PROtools","Subpopulations","Study types","Study methodologies","LocationsTags","SubpopulationsTags","DiseaseTags","InterventionsTags","StudytypesTags","StudyMethodologyTags","PROtoolTags","DateBand","C1","C2","C3","C4","C5"]
[1,"Aderaye,G.,et al. (2008). \"Evaluation of Toluidine Blue O staining for the diagnosis of Pneumocystis jiroveci in expectorated sputum sample and bronchoalveolar lavage from HIV-infected patients in a tertiary care referral center in Ethiopia.\" Infection 36(3): 237-243.",null,"Aderaye,G.,et al.","Evaluation of Toluidine Blue O staining for the diagnosis of Pneumocystis jiroveci in expectorated sputum sample and bronchoalveolar lavage from HIV-infected patients in a tertiary care referral center in Ethiopia","BACKGROUND: Pneumocystis pneumonia (PCP) is becoming increasingly recognized in sub-Saharan Africa. The currently recommended diagnostic methods using induced sputum (IS) and bronchoalveolar lavage (BAL) are neither technically feasible nor affordable for a wider clinical use in developing countries. Therefore,there is a need for a simple and affordable diagnostic test. METHODS: The yield of Toluidine Blue O (TBO) stain,immunofluorescence (IF),and polymerase chain reaction (PCR) for the diagnosis of Pneumocystis jiroveci were compared in 78 expectorated sputum and 118 BAL samples of 131 HIV-infected patients presenting with atypical chest X-ray and sputum smear-negative for acid-fast bacilli. RESULTS: A total of 56 (42.7%) patients tested positive for P. jiroveci by PCR,39 (29.4%) by IF,and 28 (21.4%) by TBO stain. The sensitivity of TBO as compared to IF and PCR was 71.4% and 34.5% in expectorated sputum and 68% and 41.5% in BAL samples,respectively,with a specificity approaching 100% in both. The sputum PCR showed high concordance rate with BAL PCR. The sensitivity and specificity of sputum PCR as compared to BALPCR was 78.9% and 89%,respectively. In both TBO and IF positive BAL samples,majority were from patients who could not produce sputum (p<0.001). The density of P. jiroveci clusters in BAL samples did not correlate with prior co-trimoxazole use,immunologic status of the patient or overall mortality. CONCLUSION: Compared to IF,TBO staining has an acceptable sensitivity and very high specificity both in expectorated sputum and BAL samples. Expectorated sputum is,therefore,the most practical specimen and TBO staining an inexpensive diagnostic method to be recommended for high-HIV,resource-constrained settings. Bronchoscopy for the diagnosis of PCP is often not required for patients who can produce sputum. For patients who cannot produce sputum,however,the cost and efficacy of TBO in IS sample needs to be investigated in resource-poor countries.","Infection,36(3): 237-243","Ethiopia",2008,"HIV",null,null,"Unknown","Diagnostic Research","Clinical Study"]
[2,"Anonymous (1995). \"Study questions increasing cost of intensive care of pneumocystis.\" AIDS Policy Law 10(2): 2.",null,"Anonymous","Study questions increasing cost of intensive care of pneumocystis","AIDS: According to a new study,intensive care for AIDS patients with severe pneumonia is becoming so expensive that policy makers may decide to ration or refuse treatments. Researchers at the University of California-San Francisco (UCSF) found that it costs an average of $215,000 to extend by one year the life of an AIDS patient who is treated for pneumocystis carinii pneumonia (PCP) in a hospital's intensive care unit. This is twice as much as comparable care cost in 1988. AIDS patients are surviving longer,with some suffering their second or third PCP infection,increasing the cost. Researchers were careful to note that rationing health care means certain death for some AIDS patients with PCP.","AIDS Policy Law,10(2): 2","Unknown",1995,"AIDS",null,null,"Unknown","Cost and Resource Use","Narrative Review"]
[3,"Asai,N.,et al. (2012). \"A successful diagnostic case of Pneumocystis pneumonia by the loop-mediated isothermal amplification method in a patient with dermatomyositis.\" J Infect Chemother 18(6): 965-969.",null,"Asai,N.,et al.","A successful diagnostic case of Pneumocystis pneumonia by the loop-mediated isothermal amplification method in a patient with dermatomyositis","Pneumocystis pneumonia (PCP) can occur in patients with many causes of the immunocompromised state other than human immunodeficiency virus (HIV). It is quite difficult to diagnose PCP without HIV because there is no method for detecting Pneumocystis jirovecii. Thus,non-HIV PCP continues to have high mortality. Recently,loop-mediated isothermal amplification (LAMP) is becoming an established nucleic acid amplification method offering rapid,accurate,and cost-effective diagnosis of infectious diseases. We report a non-HIV PCP case successfully diagnosed by the LAMP method. It was previously reported that PCR in BALF specimens had been the most sensitive method in the diagnosis of PCP without HIV. The LAMP method would be more sensitive than conventional PCR and an effective tool in the early diagnosis of PCP.","J Infect Chemother,18(6): 965-969","Japan",2012,"Dermatomyositis",null,null,"Unknown","Diagnostic Research","Case Study"]
[4,"Bastian,L.,et al. (1993). \"Differences between men and women with HIV-related Pneumocystis carinii pneumonia: experience from 3,070 cases in New York City in 1987.\" J Acquir Immune Defic Syndr 6(6): 617-623.",null,"Bastian,L.,et al.","Differences between men and women with HIV-related Pneumocystis carinii pneumonia: experience from 3,070 cases in New York City in 1987","Although women make up the fastest growing group of persons with AIDS,studies of human immunodeficiency virus (HIV)-infected persons reported to date have included predominantly or exclusively men. We evaluated sex differences in sociodemographic characteristics,hospital characteristics,in-hospital resource use,and short-term mortality rates for 2,526 men and 544 women admitted for their first-episode of HIV-related Pneumocystis carinii pneumonia (PCP) in New York City in 1987. Compared with men,women were significantly less likely to be white (81% vs. 54%,p < or = 0.001) or have private health insurance (80% vs. 58%,p < or = 0.001),and more likely to be admitted through an emergency room (79% vs. 71%,p < or = 0.001) and receive care at hospitals that had less experience treating PCP (p < or = 0.001). Women were more likely than men to die in the hospital [33% vs. 24%; crude odds ratio = 1.56,confidence interval (CI) = 1.28-1.91,p < or = 0.001]. In a logistic regression model,the risk of death in the hospital was associated with age 60-65 years [adjusted odds ratio (AOR) = 4.19,CI = 2.13-8.21],not having private health insurance (AOR = 1.37,CI = 1.08-1.75),admission through the emergency room (AOR = 1.54,CI = 1.21-1.96),and receiving care at hospitals with less experience treating PCP (AOR = 1.63,CI = 1.15-2.30),but women were not significantly more likely to die in the hospital than men (AOR = 1.18,CI = 0.93-1.50). Poorer access to medical care as well as higher use of hospitals with less experience treating AIDS may account for the difference in mortality rates observed in women with HIV-related PCP.","J Acquir Immune Defic Syndr,6(6): 617-623","USA",1993,"HIV",null,null,"Unknown","Cost and Resource Use,Mortality,Epidemiology","Retrospective Observational"]
[5,"Benfield,T. L.,et al. (1995). \"Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia.\" Respir Med 89(4): 285-290.",null,"Benfield,T. L.,et al.","Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia","Pneumocystis carinii pneumonia (PCP) may cause severe respiratory distress. This is believed to be partly caused by the accumulation of neutrophils in the lung. Interleukin-8 (IL-8) and leukotriene B4 (LTB4) are potent neutrophil chemo-attractants and activators. Eicosanoids [i.e. prostaglandins (PG) and leukotrienes (LT)] are pro-inflammatory mediators released from arachidonic acid by action of phospholipase A2 (PLA2) and have been implicated in the host response to micro-organisms. Bronchoalveolar lavage (BAL) was performed on patients with PCP as part of a randomized study of adjuvant corticosteroids vs. placebo,in addition to standard antimicrobial therapy. Re-bronchoscopy was offered at day 10. BAL fluid was available for 26 patients who had follow-up bronchoscopy performed. At diagnosis,IL-8 levels were elevated in patients with PCP,compared to healthy controls,and correlated with relative BAL neutrophilia and P(A-a)O2. LTB4 was also elevated in PCP,but failed to correlate with either BAL neutrophilia or P(A-a)O2. PLA2 activity in patients correlated with IL-8 levels and BAL neutrophilia,but not with P(A-a)O2. A trend towards a decrease in IL-8 levels in BAL fluid was detected in the corticosteroid-treated patients from days 0-10,whereas no change was detected in the placebo group. No change in levels of LTB4,LTC4,PGE2,PGF2a and PLA2 were detected cover time in either treatment group. This study establishes a correlation between IL-8,BAL neutrophilia and P(A-a)O2,and suggests a role of IL-8 as a mediator in the pathogenesis of PCP,whereas the role of eicosanoids seems less clear.","Respir Med,89(4): 285-290","Denmark",1995,"Not Specified",null,null,"Unknown","Mortality","RCT"]
[6,"Bennett,C. L.,et al. (1990). \"The relation between resource use and in-hospital mortality for patients with acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia.\" Arch Intern Med 150(7): 1447-1452.",null,"Bennett,C. L.,et al.","The relation between resource use and in-hospital mortality for patients with acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia","A central issue in health policy with regard to the acquired immunodeficiency syndrome (AIDS) is whether quality of care and patient outcomes are affected by resource constraints. In an earlier study of 15 California hospitals between October 1986 and October 1987,we observed a markedly lower in-hospital mortality rate for Pneumocystis carinii pneumonia in the group of patients treated in hospitals that had a high level of experience with AIDS relative to the group treated in hospitals with low experience. We present the patterns of resource use at hospitals with high and low AIDS familiarity. Average charges and resource use did not differ between the two groups of hospitalized patients; however,there were marked variations in how the resources were used. Among survivors,patients who received care at hospitals with high AIDS familiarity stayed in the hospital longer,underwent a bronchoscopy more often,stayed in an intensive care unit longer,and accrued higher average total charges than patients at hospitals with low AIDS familiarity. Conversely,among nonsurvivors,a greater intensity of care was received at the hospitals with low AIDS familiarity. These results suggest that,in these 15 hospitals,the markedly higher rate of in-hospital death at hospitals with low AIDS familiarity was not related to the quantity of resources that were used; rather it was related to differences in how the resources were used. Our results show that additional resources significantly improved the chances of in-hospital survival for patients at hospitals with high AIDS familiarity,but did not affect the chances of survival in hospitals with low AIDS familiarity. Our findings suggest that physicians in those hospitals in which the care of patients with AIDS is relatively infrequent might improve the chances of in-hospital survival of patients with AIDS by more timely and efficient use of resources.","Arch Intern Med,150(7): 1447-1452","USA",1990,"AIDS",null,null,"Unknown","Cost and Resource Use,Mortality","Observational"]
[7,"Bennett,C. L.,et al. (1995). \"Cost-effectiveness models of clinical trials of new pharmaceuticals for AIDS-related Pneumocystis carinii pneumonia: are they helpful to policy makers?\" Clin Perform Qual Health Care 3(3): 156-164.",null,"Bennett,C. L.,et al.","Cost-effectiveness models of clinical trials of new pharmaceuticals for AIDS-related Pneumocystis carinii pneumonia: are they helpful to policy makers?","BACKGROUND: Pneumocystis carinii pneumonia (PCP) has been the most common and most costly complication of acquired immunodeficiency syndrome (AIDS). Because of concern over the high costs of care for persons with AIDS,policy makers have instituted a number of new measures to encourage cost-effectiveness. Although the clinical efficacy of new pharmaceutical agents is evaluated extensively before approval,comparative trials of a new agent with its major competitor are sometimes not carried out,and estimates of cost-effectiveness are therefore difficult to obtain. METHODS: We describe methodologic issues associated with the development of economic models of new pharmaceutical agents and illustrate these issues with an analysis of second-line therapeutic options for PCP. RESULTS: A new drug,trimetrexate,and the standard second-line therapy,pentamidine,are both inferior to the standard first-line therapy,trimethoprim/sulfamethoxazole,as initial therapy for moderate to severe PCP. However,as many as half of the patients with PCP are either intolerant or refractory to trimethoprim/sulfamethoxazole therapy for PCP. Economic models suggest that,if the two drugs have identical survival rates,then trimetrexate,despite a higher acquisition cost,is both less expensive and more effective in achieving toxicity-free survival than pentamidine in patients who require second-line therapy for PCP. Sensitivity analyses indicate that trimetrexate is less expensive than pentamidine over a wide range of estimates of costs and effectiveness. CONCLUSIONS: To make well-informed therapeutic decisions,policy makers and physicians require head-to-head studies of a new pharmaceutical agent with its major competitor. However,economic models can be used to derive estimates of cost-effectiveness of new pharmaceutical agents when such data are lacking. The interpretation of these models raises general issues related to the perspective of the investigators,study design,estimation of costs of care,rates of response,toxicity,and survival,and generalizability of the results to other settings as well as methodologic issues that are unique to human immunodeficiency virus (HIV) disease. If a comparative trial found better survival rates,then cost-effectiveness models would be of limited usefulness; almost all physicians would use the drug with the higher survival rate.","Clin Perform Qual Health Care,3(3): 156-164","USA",1995,"AIDS","Trimetrexate,Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model","Observational"]
[8,"Bennett,C. L.,et al. (1996). \"U.S. hospital care for HIV-infected persons and the role of public,private,and Veterans Administration hospitals.\" J Acquir Immune Defic Syndr Hum Retrovirol 13(5): 416-421.",null,"Bennett,C. L.,et al.","U.S. hospital care for HIV-infected persons and the role of public,private,and Veterans Administration hospitals","Hospitals are a major provider of medical care for human immunodeficiency virus (HIV)-infected persons. Although utilization and patterns of care profiles in public and private hospitals have been evaluated for acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP),one of the most costly and common severe complications of AIDS,information from Veterans Administration (VA) hospitals has not been reported previously. This article reports on inpatient care for PCP patients by obtaining data from VA,private,and public hospitals. Cost and resource utilization data were obtained from reviews of medical records,claims,and provider bills from 26 non-VA hospitals and 18 VA hospitals in 10 cities in the United States. Data on severity of illness,patterns of care,and outcomes for PCP were obtained from medical record reviews from 2,174 PCP cases treated in 82 non-VA and 14 VA hospitals in five U.S. cities. Estimates were made of the average costs and the rates of use of diagnostic tests,anti-PCP medications,and intensive care units for samples of public hospital,private hospital,and VA patients with PCP. With mean charges for a single PCP episode of $14,500 to $16,060,PCP remains one of thea most costly complications of AIDS. Although the severity of PCP illness at admission was greatest at public hospitals,the intensity of care was lowest: for frequency of cytologic diagnosis (48% at public,62% at VA,and 66% at private hospitals),bronchoscopy (45% at public,60% at VA,and 66% at private hospitals),and intensive care unit use (11% at public,22% at VA,and 19% at private hospitals). In-hospital mortality rates for PCP also differed in the three types of hospitals (20% at public,24% at VA,and 18% at private hospitals). Patterns of PCP care differ among VA,public,and private hospitals. Future studies on the HIV epidemic should include data collected from uniform data sources from VA hospitals,in addition to public and private hospitals,to provide insight on the processes of care and outcomes for HIV-infected persons.","J Acquir Immune Defic Syndr Hum Retrovirol,13(5): 416-421","USA",1996,"HIV,AIDS",null,null,"Veterans","Cost and Resource Use","Retrospective Observational"]
[9,"Bennett,R. L.,et al. (1993). \"Improved outcomes in intensive care units for AIDS-related Pneumocystis carinii pneumonia: 1987-1991.\" J Acquir Immune Defic Syndr 6(12): 1319-1321.",null,"Bennett,R. L.,et al.","Improved outcomes in intensive care units for AIDS-related Pneumocystis carinii pneumonia: 1987-1991","Respiratory failure due to Pneumocystis carinii pneumonia (PCP) is the most common complication requiring an intensive care unit (ICU) for persons with AIDS. In this study,we evaluated patterns of ICU use for ICU patients with first-episode PCP in 15 Veterans Administration Medical Centers from 1987 to 1991. Twelve percent of all patients with PCP received care in the ICU. The survival rates improved steadily during these years. Although there was little variation in the relative frequency of ICU use,the effectiveness of ICU use appeared to improve over time. In the more recent years,relatively more survivors and relatively fewer nonsurvivors received care in an ICU. Changes in medical practice such as adjunctive use of steroids for severe cases of PCP and more effective use of scarce resources may account for the improved survival rates for patients with PCP who are treated in an ICU.","J Acquir Immune Defic Syndr,6(12): 1319-1321","USA",1993,"AIDS",null,null,"Veterans","Cost and Resource Use,Mortality","Retrospective Observational"]
[10,"Botterel,F.,et al. (2012). \"Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients.\" J Clin Microbiol 50(2): 227-231.",null,"Botterel,F.,et al.","Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients","Quantitative PCR (qPCR) is more sensitive than microscopy for detecting Pneumocystis jirovecii in bronchoalveolar lavage (BAL) fluid. We therefore developed a qPCR assay and compared the results with those of a routine immunofluorescence assay (IFA) and clinical data. The assay included automated DNA extraction,amplification of the mitochondrial large-subunit rRNA gene and an internal control,and quantification of copy numbers with the help of a plasmid clone. We studied 353 consecutive BAL fluids obtained for investigation of unexplained fever and/or pneumonia in 287 immunocompromised patients. No qPCR inhibition was observed. Seventeen (5%) samples were both IFA and qPCR positive,63 (18%) were IFA negative and qPCR positive,and 273 (77%) were both IFA and qPCR negative. The copy number was significantly higher for IFA-positive/qPCR-positive samples than for IFA-negative/qPCR-positive samples (4.2 +/- 1.2 versus 1.1 +/- 1.1 log(10) copies/mul; P < 10(-4)). With IFA as the standard,the qPCR assay sensitivity was 100% for >/=2.6 log(10) copies/mul and the specificity was 100% for >/=4 log(10) copies/mul. Since qPCR results were not available at the time of decision-making,these findings did not trigger cotrimoxazole therapy. Patients with systemic inflammatory diseases and IFA-negative/qPCR-positive BAL fluid had a worse 1-year survival rate than those with IFA-negative/qPCR-negative results (P < 10(-3)),in contrast with solid-organ transplant recipients (P = 0.88) and patients with hematological malignancy (P = 0.26). Quantifying P. jirovecii DNA in BAL fluids independently of IFA positivity should be incorporated into the investigation of pneumonia in immunocompromised patients. The relevant threshold remains to be determined and may vary according to the underlying disease.","J Clin Microbiol,50(2): 227-231","France",2012,"Immunocompromised",null,null,"Unknown","Pathology","Clinical Study"]
[11,"Castellano,A. R. and M. D. Nettleman (1991). \"Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia.\" Jama 266(6): 820-824.",null,"Castellano,A. R. and M. D. Nettleman","Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia","OBJECTIVE: To determine the relative cost and benefit of aerosolized pentamidine and the combination product of sulfamethoxazole and trimethoprim sulfate as secondary prophylaxis for Pneumocystis carinii pneumonia. DESIGN: A Markov-based cost-benefit analysis was performed. Drug efficacies,toxicities,and mortality rates were drawn from the current literature. SETTING: Hypothetical. PATIENT POPULATION: Patients infected with the human immunodeficiency virus who had had at least one episode of P carinii pneumonia. INTERVENTIONS: Regimen 1 required the use of aerosolized pentamidine as the sole first-line prophylactic agent in all patients. Regimen 2 required the use of sulfamethoxazole-trimethoprim in all patients who had no history of a toxic reaction to the drug; only patients with a history of toxic effects and those who developed toxic effects while receiving the drug would receive aerosolized pentamidine. Regimen 3 required that no secondary prophylaxis be given. MAIN OUTCOME MEASURES: Net cost,median patient survival,and 5-year survival for each regimen and for regimens 1 and 2 compared with regimen 3. MAIN RESULTS: Regimen 2 was dominant,with a net cost of $6332 per patient and a median survival of 2.050 years. Compared with no prophylaxis,regimen 2 resulted in a savings of $16,503 per patient and a 0.696-year increase in median survival. Compared with regimen 1,regimen 2 resulted in a savings of $2904 and a 0.067-year increase in median survival. CONCLUSIONS: Secondary prophylaxis for P carinii saves money and extends survival. Current data suggest that sulfamethoxazole-trimethoprim should be given whenever it can be tolerated. Use of aerosolized pentamidine as a first-line agent would result in a modest increase in cost and a decrease in life expectancy.","Jama,266(6): 820-824","USA",1991,"HIV","Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model,Mortality","Observational"]
[12,"Chaisson,R. E.,et al. (1992). \"Pneumocystis prophylaxis and survival in patients with advanced human immunodeficiency virus infection treated with zidovudine. The Zidovudine Epidemiology Group.\" Arch Intern Med 152(10): 2009-2013.",null,"Chaisson,R. E.,et al.","Pneumocystis prophylaxis and survival in patients with advanced human immunodeficiency virus infection treated with zidovudine. The Zidovudine Epidemiology Group","BACKGROUND: Pneumocystis carinii pneumonia (PCP) is a major cause of morbidity and mortality in persons with advanced human immunodeficiency virus (HIV) infection. We assessed the impact of prophylaxis for PCP on survival in patients with advanced HIV disease who were treated with zidovudine. METHODS: A cohort of 1048 patients with prior PCP (N = 437),another acquired immunodeficiency syndrome-defining diagnosis (N = 168) or acquired immunodeficiency syndrome-related complex (N = 443) and with less than 0.250 x 10(9)/L CD4 cells initiated zidovudine treatment between April 1987 and April 1988. They were then followed up for 24 months. Morbidity and mortality outcomes were assessed every 2 months. A time-dependent,Cox proportional hazards model was used to identify factors associated with new episodes of PCP and with survival. RESULTS: Three hundred thirty-six patients (32%) developed PCP after beginning treatment with zidovudine,with a 24-month actuarial rate of 41%. Patients with prior PCP were more likely to develop PCP during follow up (40%) than those without a history of PCP at entry (27% with PCP at follow-up). Other factors associated with developing PCP were baseline acquired immunodeficiency syndrome vs acquired immunodeficiency syndrome-related complex,and dose interruptions of zidovudine. Thirty-six (17%) of 210 patients who received trimethoprim-sulfamethoxazole prophylaxis developed PCP vs 299 (36%) of 838 who never received trimethoprim-sulfamethoxazole (odds ratio,0.48). One hundred seven (22%) of 483 patients who ever received aerosol pentamidine prophylaxis developed PCP vs 228 (40%) of 565 who did not receive aerosol pentamidine (odds ratio,0.55). In a time-dependent Cox proportional hazards analysis,trimethoprim-sulfamethoxazole (relative hazard,0.21; 95% confidence interval [CI],0.11 to 0.4) and aerosol pentamidine prophylaxis (relative hazard,0.25; 95% CI,0.16 to 0.39) were associated with decreased risk of PCP. Pneumocystis carinii pneumonia during follow-up was strongly associated with death when controlling for other factors (odds ratio,1.8). For all patients,aerosol pentamidine prophylaxis was associated with a reduced risk of death during follow-up (relative hazard,0.59; 95% CI,0.44 to 0.78),while trimethoprim-sulfamethoxazole showed a weaker association (relative hazard,0.74; 95% CI,0.54 to 1.1). However,there was a significantly reduced risk of death overall for patients who consistently used trimethoprim-sulfamethoxazole (relative hazard,0.55; 95% CI,0.35 to 0.88) or aerosol pentamidine (relative hazard,0.57; 95% CI,0.42 to 0.77) and this was most pronounced in patients with a baseline history of PCP. DISCUSSION AND CONCLUSIONS: Pneumocystis carinii pneumonia was common in advanced HIV infection treated with zidovudine. Prophylaxis with trimethoprim-sulfamethoxazole and aerosol pentamidine both were associated with a decreased likelihood of PCP,and consistent use of each was associated with improved survival. Prophylaxis for PCP is associated with prolonged survival for patients with advanced HIV disease.","Arch Intern Med,152(10): 2009-2013","USA",1992,"HIV","Zidovudine,Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality,Cross-Sectional","Retrospective Observational"]
[13,"Chouaid,C.,et al. (1993). \"Cost effectiveness of noninvasive oxygen saturation measurement during exercise for the diagnosis of Pneumocystis carinii pneumonia.\" Am Rev Respir Dis 147(6 Pt 1): 1360-1363.",null,"Chouaid,C.,et al.","Cost effectiveness of noninvasive oxygen saturation measurement during exercise for the diagnosis of Pneumocystis carinii pneumonia","We assessed (1) the sensitivity and specificity of exercise oxygen saturation measurement (EOS) for the diagnosis of Pneumocystis carinii pneumonia (PCP); and (2) the cost of introducing this indirect diagnostic test compared with that of standard diagnostic strategies for PCP. In a prospective study,85 HIV-infected patients with suspected PCP underwent EOS,followed by induced sputum (IS) and bronchoalveolar lavage (BAL) if IS was negative for P. carinii. The prevalence of PCP was 0.22,the sensitivity of IS was 0.6,and its specificity was perfect. The cost ratios of IS to BAL and EOS to BAL were 0.1 and 0.2,respectively. A desaturation of three points was the best cutoff point,giving perfect sensitivity and a specificity of 0.77. The cost analysis showed that the introduction of EOS into diagnostic strategies for PCP is highly justified when the local prevalence is low. Exercise oxygen saturation measurement is simple and safe,and the results are available rapidly; its sensitivity is perfect and its specificity good. Its economic utility depends on its cost and the local prevalence of PCP in the test population.","Am Rev Respir Dis,147(6 Pt 1): 1360-1363","France",1993,"HIV",null,null,"Unknown","Cost and Resource Use,Diagnostic Research","Clinical Study"]
[14,"Chouaid,C.,et al. (1995). \"Cost-analysis of four diagnostic strategies for Pneumocystis carinii pneumonia in HIV-infected subjects.\" Eur Respir J 8(9): 1554-1558.",null,"Chouaid,C.,et al.","Cost-analysis of four diagnostic strategies for Pneumocystis carinii pneumonia in HIV-infected subjects","The aim of this study was to analyse the cost-effectiveness ratio of four diagnostic strategies for Pneumocystis carinii pneumonia (PCP) in patients infected with human immunodeficiency virus (HIV). Two hundred and ten HIV-infected patients with suspected PCP underwent induced-sputum (IS) followed,if negative,by bronchoalveolar lavage (BAL); 85 of these patients were able to undergo an exercise test (ET),prior to induced sputum and BAL. The following strategies were analysed: BAL strategy (BAL whenever PCP is suspected); IS strategy (induced sputum followed by BAL if negative); exercise test (ET) strategy,(ET followed by BAL if the results are abnormal); and the ES (exercise sputum) strategy (i.e. BAL only after abnormal ET and negative IS). The cost of each strategy was calculated by taking into account only direct costs; the conditions in which two given strategies would be cost-equivalent were also evaluated. The prevalence of PCP in this population was 31%; IS had 100% specificity and 71% sensitivity,whilst ET had 100% sensitivity and 77% specificity. The costs of BAL,IS,ET and ES strategies were 210,000,191,940,140,700 and 112,700 FF,respectively. The ES strategy is,thus,most suitable for our unit. The most economic strategy depends not only on the cost and characteristics of the procedures,but also on the prevalence of PCP in the test population. In conclusion,we developed a model for use by diagnostic centres in choosing the most suitable strategy,on the basis of the local prevalence of PCP.","Eur Respir J,8(9): 1554-1558","France",1995,"HIV","Exercise test",null,"Unknown","Cost and Resource Use,Epidemiology,Diagnostic Research","Clinical Study"]
[15,"Chouaid,C.,et al. (1995). \"Use of the polymerase chain reaction technique on induced-sputum samples for the diagnosis of Pneumocystis carinii pneumonia in HIV-infected patients. A clinical and cost-analysis study.\" Am J Clin Pathol 104(1): 72-75.",null,"Chouaid,C.,et al.","Use of the polymerase chain reaction technique on induced-sputum samples for the diagnosis of Pneumocystis carinii pneumonia in HIV-infected patients. A clinical and cost-analysis study","The purpose of this study was to assess the sensitivity and specificity of the polymerase chain reaction (PCR) on induced sputum (IS) for the diagnosis of Pneumocystis carinii pneumonia (PCP) in HIV-infected patients,as well as its diagnostic value and cost as a routine clinical tool. Forty-nine patients with suspected PCP who had IS were studied and if negative,followed by bronchoalveolar lavage (BAL). Pneumocystis carinii was detected in these samples using standard staining techniques. Polymerase chain reaction was used with IS samples in a blinded fashion. The patients with negative BAL samples were closely monitored for 1 month. In the absence of any clinical or radiologic features of PCP during this period,they were considered as being free of PCP. The cost analysis considered only the direct costs of the various tests in three diagnostic strategies: routine BAL (BAL); IS with standard staining,if negative,followed by BAL (IS); and IS with standard staining followed,if negative,by PCR on IS samples (PCR-IS). Using standard staining P carinii was found in 13 cases (6 IS and 7 BAL). None of the 36 patients with negative BAL developed further signs of PCP. Thus,the prevalence of PCP was 26.5% and the sensitivity and specificity of BAL were 100%. Standard staining of IS had a specificity of 100% and a sensitivity of 46.5%. The sensitivity and specificity of PCR-IS were each 100%. The costs of strategies BAL,IS,and PCR-IS were $14,010,$18,300,and $18,040,respectively. The costs of the BAL strategy depended only on the cost of the relevant tests,whereas the costs of strategies IS and PCR-IS depended on the costs of the tests,the sensitivity of IS with standard staining,and the prevalence of PCP in the test population. The routine clinical use of PCR-IS is currently limited by the time required to obtain the results.","Am J Clin Pathol,104(1): 72-75","France",1995,"HIV",null,null,"Unknown","Cost and Resource Use,Diagnostic Research","Clinical Study"]
[16,"Chung,J. B.,et al. (2000). \"Cost-effectiveness of prophylaxis against Pneumocystis carinii pneumonia in patients with Wegner's granulomatosis undergoing immunosuppressive therapy.\" Arthritis Rheum 43(8): 1841-1848.",null,"Chung,J. B.,et al.","Cost-effectiveness of prophylaxis against Pneumocystis carinii pneumonia in patients with Wegner's granulomatosis undergoing immunosuppressive therapy","OBJECTIVE: To assess the incremental cost-effectiveness of 3 Pneumocystis carinii pneumonia (PCP) prophylaxis strategies in patients with Wegener's granulomatosis (WG) receiving immunosuppressive therapies: 1) no prophylaxis; 2) trimethoprim/sulfamethoxazole (TMP/SMX) 160 mg/800 mg 3 times a week,which is discontinued if patients experience an adverse drug reaction (ADR); and 3) TMP/SMX 160 mg/800 mg 3 times a week,which is replaced by monthly aerosolized pentamidine (300 mg) if patients experience an ADR. METHODS: A Markov state-transition model was developed to follow a hypothetical cohort of WG patients over their lifetimes starting from the time of initial exposure to the immunosuppressive therapy. The effect of PCP prophylaxis on life expectancy,quality-adjusted life expectancy,average discounted lifetime cost (ADLC),and incremental cost-effectiveness was estimated based on data obtained from a literature review. Direct medical costs were examined from a societal perspective,and costs and benefits were discounted at 3% annually. RESULTS: No prophylaxis resulted in a life expectancy of 13.36 quality-adjusted life years (QALY) at an ADLC of $4,538. In comparison,prophylaxis with TMP/ SMX alone increased the QALY to 13.54 and was cost saving,with an ADLC of $3,304. The addition of pentamidine in patients who had an ADR to TMP/SMX resulted in 13.61 QALY,with an ADLC of $7,428. Compared with TMP/SMX alone,TMP/SMX followed by pentamidine increased the QALY by 0.07 at an incremental cost of $58,037 per QALY. Both TMP/SMX alone and TMP/SMX followed by pentamidine prophylaxis strategies dominated the no prophylaxis strategy until the incidence of PCP fell below 0.2% and 2.25%,respectively. Institution of pentamidine therapy for patients with a TMP/SMX ADR increased quality-adjusted life expectancy compared with that with TMP/ SMX alone until the incidence of PCP rose above 7.5%. CONCLUSION: Prophylaxis using TMP/SMX alone increased life expectancy and reduced cost for patients with WG receiving immunosuppressive therapy. Replacing TMP/SMX with monthly aerosolized pentamidine in cases of ADR further increased life expectancy,although at an increased cost.","Arthritis Rheum,43(8): 1841-1848","USA",2000,"Wegner's granulomatosis","Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model","Observational"]
[17,"Crabtree-Ramirez,B.,et al. (2016). \"Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America.\" PLoS One 11(6): e0153921.",null,"Crabtree-Ramirez,B.,et al.","Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America","BACKGROUND: Since 2009,earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in \"real life\" settings in Latin America has not been evaluated. METHODS: Patients in the Caribbean,Central and South America network for HIV Epidemiology (CCASAnet) >/=18 years of age at enrolment,from 2001-2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models. RESULTS: A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina,686 from Brazil,283 from Chile,119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%),followed by Pneumocystis pneumonia (24%),Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8-12.1) weeks before 2009 to 4.3 (IQR 2.0-7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001),having a non-tuberculosis OI (p<0.001),study site (p<0.001),and more recent years of OI diagnosis (p<0.001). DISCUSSION: The time from diagnosis of an OI to HAART initiation has decreased in Latin America coinciding with the publication of evidence of its benefit. We found important heterogeneity between sites which may reflect differences in clinical practices,local guidelines,and access to HAART. The impact of the timing of HAART initiation after OI on patient survival in this \"real life\" context needs further evaluation.","PLoS One,11(6): e0153921","Argentina,Brazil,Chile,Honduras,Mexico",2016,"HIV,AIDS",null,null,"Adults","Mortality,Cross-Sectional","Retrospective Observational"]
[18,"Creemers-Schild,D.,et al. (2016). \"Treatment of Pneumocystis pneumonia with intermediate-dose and step-down to low-dose trimethoprim-sulfamethoxazole: lessons from an observational cohort study.\" Infection 44(3): 291-299.",null,"Creemers-Schild,D.,et al.","Treatment of Pneumocystis pneumonia with intermediate-dose and step-down to low-dose trimethoprim-sulfamethoxazole: lessons from an observational cohort study","BACKGROUND: The recommended treatment of Pneumocystis jirovecii pneumonia (PCP) is high-dose trimethoprim-sulfamethoxazole (TMP-SMX) in an equivalent of TMP 15-20 mg/kg/day and SMX 75-100 mg/kg/day for 2 or 3 weeks. High rates of adverse events are reported with this dose,which raises the question if lower doses are possible. METHODS: All adult patients diagnosed with PCP in various immune dysfunctions and treated with TMP-SMX between January 1,2003 and July 1,2013 in a tertiary university hospital were included. Per institutional protocol,patients initiated treatment on intermediate-dose TMP-SMX (TMP 10-15 mg/kg/day) and could be stepped down to low-dose TMP-SMX (TMP 4-6 mg/kg/day) during treatment. Clinical variables at presentation,relapse rate and mortality rates were compared between intermediate- and step-down treatment groups by uni- and multivariate analyses. RESULTS: A total of 104 patients were included. Twenty-four patients (23 %) were switched to low-dose TMP-SMX after a median of 4.5 days (IQR 2.8-7.0 days). One relapse (4 %) occurred in the step-down group versus none in the intermediate-dose group. The overall 30-day mortality was 13 %. There was 1 death in the step-down group (4 %) compared to 13 deaths (16 %) in the intermediate-dose group. CONCLUSIONS: We observed high cure rates of PCP by treatment with intermediate-dose TMP-SMX. In addition,a step-down strategy to low-dose TMP-SMX during treatment in selected patients appears to be safe and does not compromise the outcome of treatment.","Infection,44(3): 291-299","Netherlands",2016,"Not Specified","Trimethoprim-sulfamethoxazole",null,"Adults","Mortality,Cross-Sectional","Retrospective Observational"]
[19,"Cregan,P.,et al. (1990). \"Comparison of four methods for rapid detection of Pneumocystis carinii in respiratory specimens.\" J Clin Microbiol 28(11): 2432-2436.",null,"Cregan,P.,et al.","Comparison of four methods for rapid detection of Pneumocystis carinii in respiratory specimens","Four stains for the detection of Pneumocystis carinii in respiratory specimens were compared for sensitivity,specificity,preparation time,and ease of interpretation. One hundred specimens were collected. Of these,50 were induced sputum specimens and 50 were bronchoalveolar lavage fluid. All specimens were stained with Diff-Quik (DQ) (a modified Giemsa stain),a quick silver stain,and direct and indirect immunofluorescence stains. A positive specimen was defined as any smear positive by two or more of the methods. Fifty-eight percent of specimens were positive. Seventy-four percent of the sputum specimens and 42% of the bronchoalveolar lavages were positive. The sensitivities for detection of P. carinii in sputum were 92% with silver stain,97% with direct immunofluorescence assay (DFA),97% with indirect immunofluorescence assay (IFA),and 92% with DQ. The sensitivities for detection in bronchoalveolar lavage were 86% with silver stain,90% with DFA,86% with IFA,and 81% with DQ. Preparation times varied from 90 min for the silver stain and IFA to 3 min for DQ. Costs of the tests varied from $1.50 per slide for DQ to $10.00 per slide for the silver stain and DFA. Reading times varied from 10 to 30 min for the silver stain and DQ to less than 5 min for the immunofluorescence assays. We conclude that all of these tests are viable options for the clinical laboratory,and the choice will be influenced by factors such as clinical volume,ability to batch specimens,and expertise of technological support. A reasonable option may be to use the quick and inexpensive DQ as a screening test and to confirm negative smears with a more sensitive assay.","J Clin Microbiol,28(11): 2432-2436","USA",1990,"Not Specified",null,null,"Unknown","Diagnostic Research","Clinical Study"]
[20,"del Rio,C.,et al. (1988). \"Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.\" Arch Pathol Lab Med 112(12): 1229-1232.",null,"del Rio,C.,et al.","Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome","To examine the role of sputum examination in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS),we conducted a prospective study of 30 patients with AIDS or suspected AIDS. Sputum was obtained just prior to bronchoscopy by spontaneous cough (20 patients) or by induction with a saline nebulizer (ten patients). Pneumocystis carinii was diagnosed by bronchoalveolar lavage in 13 of the 30 patients; two of these patients had P carinii organisms identified in sputum specimens (sensitivity of sputum,15.3%; negative predictive value,60.7%). A cost-analysis study demonstrated that sputum examination is not cost effective when the sensitivity is below 24%. We conclude that P carinii can be diagnosed from expectorated sputum in patients with AIDS,but,because of the test's low sensitivity,it cannot be recommended in the routine evaluation of patients with AIDS and pulmonary complaints.","Arch Pathol Lab Med,112(12): 1229-1232","USA",1988,"AIDS",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Prospective Cohort"]
[21,"Desoubeaux,G.,et al. (2017). \"Use of calcofluor-blue brightener for the diagnosis of Pneumocystis jirovecii pneumonia in bronchial-alveolar lavage fluids: A single-center prospective study.\" Med Mycol 55(3): 295-301.",null,"Desoubeaux,G.,et al.","Use of calcofluor-blue brightener for the diagnosis of Pneumocystis jirovecii pneumonia in bronchial-alveolar lavage fluids: A single-center prospective study","The biological diagnosis of Pneumocystis jirovecii pneumonia (PjP) is based on the investigation of respiratory fluids by conventional staining methods and/or molecular biology. Diagnostic performance of an in-house technique based on calcofluor-blue brightener for the direct detection of P. jirovecii cysts was prospectively assessed in bronchial-alveolar lavage fluids (BALF) from patients with a suspected PjP infection over a three-year period in a single center: the diagnostic yield was compared to that of a commercial kit based on monoclonal immunofluorescence assay (IFA) on replicate smears. May-Grunwald Giemsa (MGG) staining and quantitative Polymerase Chain Reaction (qPCR) were also performed. The gold standard for each patient was the definitive diagnosis of PjP infection by an independent committee based on clinical,radiological,and biological data. Overall,481 BALF were assessed: 42 were found to be positive for the detection of P. jirovecii by at least one laboratory technique,but only 35 were actually judged to be in agreement with the definitive diagnosis of PjP infection. The sensitivity of the calcofluor-blue brightener technique was 74.3% vs. 60.0%,34.6%,and 82.9% for IFA,MGG,and qPCR,respectively; and its specificity was 99.6% vs. 99.3%,100.0%,and 99.4% for IFA,MGG,and qPCR. No technique was shown to be statistically superior to calcofluor-blue brightener. Further validation of the test through multicenter studies is now required,but in light of its low cost and easy preparation,the use of calcofluor-blue brightener in BALF appears to be a valuable alternative method for the routine first-line diagnosis of PjP infection.","Med Mycol,55(3): 295-301","France",2017,"Not Specified",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Prospective Cohort"]
[22,"Esteves,F.,et al. (2015). \"Diagnosis of Pneumocystis pneumonia: evaluation of four serologic biomarkers.\" Clin Microbiol Infect 21(4): 379.e371-310.",null,"Esteves,F.,et al.","Diagnosis of Pneumocystis pneumonia: evaluation of four serologic biomarkers","The diagnosis of Pneumocystis pneumonia (PCP) relies on microscopic visualization of Pneumocystis jirovecii organisms or DNA detection in pulmonary specimens. This study aimed to assess the usefulness of (1-3)-beta-d-glucan (BG),Krebs von den Lungen-6 antigen (KL-6),lactate dehydrogenase (LDH) and S-adenosyl methionine (SAM) as serologic biomarkers in the diagnosis of PCP. Serum levels of BG,KL-6,LDH and SAM were investigated in 145 Portuguese patients,50 patients from the Netherlands,25 Spanish patients and 40 Portuguese blood donors. Data on clinical presentation,chest imaging and gasometry tests were available. PCP cases were confirmed by microscopy and PCR techniques. A cost-effectiveness analysis was performed. BG was found to be the most reliable serologic biomarker for PCP diagnosis,followed by KL-6,LDH and SAM. The BG/KL-6 combination test was the most accurate serologic approach for PCP diagnosis,with 94.3% sensitivity and 89.6% specificity. Although less sensitive/specific than the reference standard classic methods based on bronchoalveolar lavage followed by microscopic or molecular detection of P. jirovecii organisms,the BG/KL-6 test may provide a less onerous procedure for PCP diagnosis,as it uses a minimally invasive and inexpensive specimen (blood),which may be also a major benefit for the patient's care. The BG/KL-6 combination test should be interpreted within the clinical context,and it may be used as a preliminary screening test in patients with primary suspicion of PCP,or as an alternative diagnostic procedure in patients with respiratory failure or in children,avoiding the associated risk of complications by the use of bronchoscopy.","Clin Microbiol Infect,21(4): 379.e371-310","Portugal,Netherlands,Spain",2015,"Not Specified",null,null,"Children","Diagnostic Research,Cost and Resource Use","Prospective Cohort"]
[23,"Fatti,G. L.,et al. (2006). \"Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus.\" Int J Infect Dis 10(4): 282-285.",null,"Fatti,G. L.,et al.","Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus","BACKGROUND: Pneumocystis pneumonia (PCP) caused by Pneumocystis jiroveci is common in HIV-infected children,producing substantial morbidity and mortality. Initiation of timely,effective therapy depends on clinical identification of children with PCP. OBJECTIVE: To develop a clinical decision rule to diagnose PCP in HIV-infected children for use where diagnostic resources are limited. METHODS: Analysis of data collected during a prospective incidence study of the etiology,features,and outcome of HIV-infected children hospitalized with pneumonia. RESULTS: Four clinical variables were independently associated with a diagnosis of PCP in multivariate analysis: age < 6 months (OR 15.6; 95% CI 2.4-99.8; p = 0.004),respiratory rate > 59 breaths/min (OR 8.1; 95% CI 1.5-53.2; p = 0.018),arterial percentage hemoglobin oxygen saturation (SaO2) < or = 92% (OR 5.1; 95% CI 1.0-26.1; p = 0.052) and absence of history of vomiting (OR 11.2; 95% CI 1.9-68.0; p = 0.008). The sensitivity and specificity of diagnosing PCP with any two or more of these variables were 1.00 (95% CI 0.74-1.00) and 0.49 (95% CI 0.39-0.59),respectively. Diagnosing PCP with three or more of the indicators had a decreased sensitivity of 0.75 (95% CI 0.43-0.95) and increased specificity of 0.90 (95% CI 0.83-0.95). CONCLUSION: Empirical anti-pneumocystis therapy should be considered in HIV-infected infants presenting with tachypnea,hypoxia and absence of vomiting.","Int J Infect Dis,10(4): 282-285","South Africa",2006,"HIV",null,null,"Children","Diagnostic Research","Prospective Cohort"]
[24,"Freedberg,K. A.,et al. (1991). \"Primary prophylaxis for Pneumocystis carinii pneumonia in HIV-infected people with CD4 counts below 200/mm3: a cost-effectiveness analysis.\" J Acquir Immune Defic Syndr 4(5): 521-531.",null,"Freedberg,K. A.,et al.","Primary prophylaxis for Pneumocystis carinii pneumonia in HIV-infected people with CD4 counts below 200/mm3: a cost-effectiveness analysis","We developed a decision-analytic model to assess the effectiveness and costs of dapsone,trimethoprim-sulfamethoxazole,or aerosolized pentamidine as initial prophylaxis for Pneumocystis carinii pneumonia in human immunodeficiency virus-infected people without prior symptoms AIDS and with CD4 counts less than 200/mm3. Each strategy increased life expectancy by about 18% compared with no prophylaxis; annual per-person costs were $440,$700,and $1,680 for dapsone,trimethoprim-sulfamethoxazole,and aerosolized pentamidine,respectively. These cost differences make a strategy beginning with dapsone most cost effective,with an incremental cost-effectiveness ratio of $13,400 per life year saved compared with no prophylaxis. Aerosolized pentamidine was substantially less cost effective,but the incremental cost effectiveness ratios were highly dependent on estimates for quality of life,efficacy,toxicity,and compliance. We conclude that,based on currently available data,initial prophylaxis with either dapsone or trimethoprim-sulfamethoxazole is most cost effective. For every 100,000 people treated,starting prophylaxis with trimethoprim-sulfamethoxazole or dapsone--with crossover to aerosolized pentamidine if oral therapy is not tolerated--may save between $98 million and $124 million per year.","J Acquir Immune Defic Syndr,4(5): 521-531","USA",1991,"AIDS","Trimethoprim-sulfamethoxazole,Pentamidine,Dapsone",null,"Unknown","Economic Model","Observational"]
[25,"Freedberg,K. A.,et al. (1996). \"Validating literature-based models with direct clinical trial results: the cost-effectiveness of secondary prophylaxis for PCP in AIDS patients.\" Med Decis Making 16(1): 29-35.",null,"Freedberg,K. A.,et al.","Validating literature-based models with direct clinical trial results: the cost-effectiveness of secondary prophylaxis for PCP in AIDS patients","OBJECTIVE: To compare literature-based estimates of the cost-effectiveness ratios of strategies for secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) in AIDS patients with estimates obtained using data from a recent comparative clinical trial. DESIGN: A decision-analytic Markov model with data on drug efficacy and toxicity from both the medical literature and a national randomized clinical trial. Drug costs were from average wholesale prices. Discounted life expectancy,total direct medical costs,and cost-effectiveness were projected in dollars per year of life saved (YLS). SETTING: Hypothetical for the literature-based model,then the clinical trial results from the multicenter AIDS Clinical Trials Group (ACTG Protocol 021). PATIENT POPULATION: Patients with AIDS and a prior episode of PCP. INTERVENTIONS: Strategies included no prophylaxis,TMP-SMX (160/800 mg) daily,or aerosolized pentamidine (300 mg) monthly. Patients experiencing major toxic reactions to either medication would cross over to the other agent. MAIN RESULTS: In the literature-based model no prophylaxis was associated with a projected life expectancy of 1.430 years,and total direct cost of $42,080. TMP-SMX increased life expectancy to 2.051 years and cost to $42,300; for aerosolized pentamidine life expectancy was 2.066 years and cost $43,960. TMP-SMX had an incremental cost-effectiveness ratio of $350 per YLS compared with no prophylaxis; the incremental ratio for aerosolized pentamidine was $2,950 per YLS when compared with no prophylaxis,but rose to $110,880 per YLS compared with TMP-SMX. When data from ACTG clinical trial 021 were utilized in the model,the incremental cost-effectiveness ratio for TMP-SMX compared with no prophylaxis was $720 per YLS; aerosolized pentamidine was not cost-effective,and was \"dominated\" by TMP-SMX because it was associated with higher costs and shorter life expectancy. CONCLUSIONS: Literature-based cost-effectiveness models are useful in developing health policy before clinical trials are completed. Clinical trial results,when available,can be used to validate and revise these models. For secondary PCP prophylaxis in AIDS patients,TMP-SMX is substantially more cost-effective than aerosolized pentamidine.","Med Decis Making,16(1): 29-35","USA",1996,"AIDS","Trimethoprim-sulfamethoxazole,Pentamidine",null,"Unknown","Economic Model","Observational"]
[26,"Gallant,J. E.,et al. (1995). \"The impact of prophylaxis on outcome and resource utilization in Pneumocystis carinii pneumonia.\" Chest 107(4): 1018-1023.",null,"Gallant,J. E.,et al.","The impact of prophylaxis on outcome and resource utilization in Pneumocystis carinii pneumonia","STUDY OBJECTIVE: Pneumocystis carinii pneumonia (PCP) is a major late complication of HIV infection associated with morbidity and mortality. Because chemoprophylaxis is highly effective,cases of PCP can be viewed as failures in the management of HIV disease. METHODS: We reviewed demographic,clinical,and cost data for all cases of confirmed HIV-related PCP at The Johns Hopkins Hospital in 1991 to determine consequences of missed prophylaxis. We also analyzed hospital discharge data for Maryland in 1991 to assess hospital charges,length of stay,and outcome for all patients with a principal diagnosis of HIV-related PCP. RESULTS: Pneumocystis carinii pneumonia was diagnosed in 79 patients. Of the 79 patients,61 (77%) did not receive prophylaxis,including 26 who were not previously known to have HIV infection,17 who did not have prophylaxis prescribed,and 18 who had prophylaxis prescribed,but were not compliant with the regimen. Patients not taking prophylaxis accounted for all 12 deaths ascribed to PCP. This group also accounted for 85% of the hospital days,100% of the ICU days,and 89% of the inpatient charges. The total hospital charges were $849,540. Extrapolation of these figures for the state of Maryland suggest that the failure to receive prophylaxis in 1991 resulted in 62 patient deaths and a cost of approximately $4.7 million. CONCLUSION: Patients who developed PCP despite prophylaxis had a better outcome and used fewer resources than patients not receiving preventive therapy. This study emphasizes the impact of PCP prophylaxis on the morbidity,mortality,and economics of HIV health care.","Chest,107(4): 1018-1023","USA",1995,"HIV",null,null,"Unknown","Cost and Resource Use,Mortality","Retrospective Observational"]
[27,"Glenny,R. W. and D. J. Pierson (1992). \"Cost reduction in diagnosing Pneumocystis carinii pneumonia. Sputum induction versus bronchoalveolar lavage as the initial diagnostic procedure.\" Am Rev Respir Dis 145(6): 1425-1428.",null,"Glenny,R. W. and D. J. Pierson","Cost reduction in diagnosing Pneumocystis carinii pneumonia. Sputum induction versus bronchoalveolar lavage as the initial diagnostic procedure","Sputum induction (SI) is a sensitive and specific method for diagnosing Pneumocystis carinii pneumonia (PCP) in patients with AIDS. Although less expensive than bronchoscopy with bronchoalveolar lavage (BAL),SI followed by BAL does not necessarily reduce costs compared with BAL alone. Cost analysis demonstrates that the cost of diagnosing PCP is dependent on the prevalence of PCP (PCPprevalence) in the studied population,the sensitivity of SI (SIsensitivity) for diagnosing PCP,and the relative costs of SI and BAL (SIcost and BALcost) for diagnosing PCP. In any given clinical setting,SI reduces the cost of diagnosing PCP if (PCPprevalence)(SIsensitivity) greater than SIcost/BALcost. A graphic approach relating these parameters is also presented. Evaluation of reported PCPprevalence and SIsensitivity from recent literature illustrates that SI is not always the least costly method for diagnosing PCP. Cost reduction is not the only measure of a diagnostic procedure's value,and other aspects,such as discomfort,availability,risks,and patient prognosis,must be considered. The cost analysis approach used in this study identifies those variables that can be manipulated to reduce the cost of diagnosing PCP.","Am Rev Respir Dis,145(6): 1425-1428","USA",1992,"AIDS",null,null,"Unknown","Cost and Resource Use,Diagnostic Research","Narrative Review"]
[28,"Goldie,S. J.,et al. (2002). \"Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelines.\" Arch Intern Med 162(8): 921-928.",null,"Goldie,S. J.,et al.","Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelines","BACKGROUND: Human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) have experienced a dramatic decrease in Pneumocystis carinii pneumonia (PCP),necessitating reassessment of clinical guidelines for prophylaxis. METHODS: A simulation model of HIV infection was used to estimate the lifetime costs and quality-adjusted life expectancy (QALE) for alternative CD4 cell count criteria for stopping primary PCP prophylaxis in patients with CD4 cell count increases receiving HAART and alternative agents for second-line PCP prophylaxis in those intolerant of trimethoprim-sulfamethoxazole (TMP/SMX). The target population was a cohort of HIV-infected patients in the United States with initial CD4 cell counts of 350/microL who began PCP prophylaxis after their first measured CD4 lymphocyte count less than 200/microL. Data were from randomized controlled trials and other published literature. RESULTS: For patients with CD4 cell count increases during HAART,waiting to stop prophylaxis until the first observed CD4 cell count was greater than 300/microL prevented 9 additional cases per 1000 patients and cost $9400 per quality-adjusted life year (QALY) gained compared with stopping prophylaxis at 200/microL. For patients intolerant of TMP/SMX,using dapsone increased QALE by 2.7 months and cost $4500 per QALY compared with no prophylaxis. Using atovaquone rather than dapsone provided only 3 days of additional QALE and cost more than $1.5 million per QALY. CONCLUSIONS: Delaying discontinuation of PCP prophylaxis until the first observed CD4 cell count greater than 300/microL is cost-effective and provides an explicit \"PCP prophylaxis stopping criterion.\" In TMP/SMX-intolerant patients,dapsone is more cost-effective than atovaquone.","Arch Intern Med,162(8): 921-928","USA",2002,"HIV","Atovaquone,Dapsone,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model","Observational"]
[29,"Harris,J. R.,et al. (2011). \"Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP).\" PLoS One 6(8): e23158.",null,"Harris,J. R.,et al.","Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP)","BACKGROUND: Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging,particularly in developing countries. Highly sensitive diagnostic methods are costly,while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. METHODS AND FINDINGS: We compared cost-effectiveness,as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated,of 33 PCP diagnostic options,involving combinations of specimen collection methods [oral washes,induced and expectorated sputum,and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)],or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory,HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence,diagnostic procedures involving expectorated sputum with any PCR method,or induced sputum with nested or real-time PCR,were all highly cost-effective,successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit,successfully treating 68-90% of patients at costs of $189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained,successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients,though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options. CONCLUSIONS: For diagnosis of PCP,use of PCR technologies,when combined with less-invasive patient specimens such as expectorated or induced sputum,represent more cost-effective options than any diagnostic procedure using BAL,or chest x-ray alone.","PLoS One,6(8): e23158","USA",2011,"HIV",null,null,"Unknown","Economic Model,Diagnostic Research","Clinical Study"]
[30,"Hibberd,P. L.,et al. (1992). \"Trimethoprim-sulfamethoxazole compared with ciprofloxacin for the prevention of urinary tract infection in renal transplant recipients. A double-blind,randomized controlled trial.\" Online J Curr Clin Trials Doc No 15: [4083 words; 4046 paragraphs].",null,"Hibberd,P. L.,et al.","Trimethoprim-sulfamethoxazole compared with ciprofloxacin for the prevention of urinary tract infection in renal transplant recipients. A double-blind,randomized controlled trial","BACKGROUND: Prophylaxis with low-dose trimethoprim-sulfamethoxazole has been shown to be cost-effective in the prevention of urinary tract infections,pyelonephritis,urosepsis,and pneumocystis pneumonia in renal transplant recipients. Ciprofloxacin,effective against almost all urinary tract pathogens in this patient population,represents a promising alternative prophylactic agent for patients unable to tolerate trimethoprim-sulfamethoxazole due to toxicity. METHODS: We conducted a randomized,double-blind trial to compare low-dose trimethoprim-sulfamethoxazole with ciprofloxacin for the prevention of urinary tract infections in renal transplant recipients. Patients received either ciprofloxacin (250 mg) or trimethoprim-sulfamethoxazole (80 mg trimethoprim,400 mg sulfamethoxazole) daily for 6 months following transplantation. Treatment was considered successful if patients completed the 6-month course and 3-month follow-up period without evidence of urinary tract infection or drug-related toxicities. RESULTS: Of 103 eligible patients,51 received ciprofloxacin and 52 received trimethoprim-sulfamethoxazole. At 6 months,treatment was successful in 75% (38 of 51) receiving ciprofloxacin and 71% (37 of 52) treated with trimethoprim-sulfamethoxazole (P = 0.87,relative risk 1.04,95% confidence limits 0.83 to 1.33). Thirteen patients (25%) receiving trimethoprim-sulfamethoxazole withdrew from the study-4 for resistant urinary tract infection and 9 for drug-related toxicity,while 3 (6%) of the patients receiving ciprofloxacin withdrew because of drug-related toxicity (P = 0.016,relative risk of urinary tract infection or adverse event 0.24,95% confidence limits 0.07 to 0.78). At 9 months,all 38 patients who completed the 6-month course of ciprofloxacin remained free of urinary tract infection,while an additional 4 patients who had received trimethoprim-sulfamethoxazole prophylaxis (total of 8 patients over the 9 months) developed urinary tract infections (P = 0.006,Fisher's exact test for urinary tract infection alone). Pneumocystis pneumonia occurred in a total of 7 (14%) patients who were randomized to ciprofloxacin,but 2 of the 7 had withdrawn from the study at least 2 weeks prior to the diagnosis of pneumocystis pneumonia. There were no cases of pneumocystis pneumonia in patients receiving trimethoprim-sulfamethoxazole (P = 0.006). Following completion of the study,monthly aerosolized pentamidine administered in conjunction with ciprofloxacin has provided complete protection against urinary tract infection and pneumocystis pneumonia in 30 transplant recipients unable to tolerate trimethoprim-sulfamethoxazole therapy. CONCLUSIONS: Ciprofloxacin is at least as effective as trimethoprim-sulfamethoxazole in the prevention of urinary tract infection in renal transplant recipients,and is better tolerated. Ciprofloxacin prophylaxis is associated with a higher incidence of pneumocystis pneumonia than is trimethoprim-sulfamethoxazole therapy. An uncontrolled follow-up study suggests that ciprofloxacin prophylaxis combined with monthly aerosolized pentamidine may be efficacious in preventing both urinary tract infection and pneumocystis pneumonia in renal transplant recipients.","Online J Curr Clin Trials,Doc No 15([4083 words; 4046 paragraphs]","USA",1992,"Not Specified","Trimethoprim-sulfamethoxazole,Ciprofloxacin",null,"Unknown","Mortality","RCT"]
[31,"Hoover,D. R. (1995). \"The effects of long term zidovudine therapy and Pneumocystis carinii prophylaxis on HIV disease. A review of the literature.\" Drugs 49(1): 20-36.",null,"Hoover,D. R.","The effects of long term zidovudine therapy and Pneumocystis carinii prophylaxis on HIV disease. A review of the literature","Two lines of attack have been used against HIV-1 disease: (1) antiretroviral therapy (notably zidovudine) directed against the HIV-1 virus; and (2) chemoprophylaxis against end-stage diseases of HIV-1 infection,most notably against Pneumocystis carinii pneumonia. Many studies and clinical trials have found that zidovudine and P. carinii prophylaxis each significantly reduce short term morbidity and mortality from HIV-1 disease. However,these drugs have costs,adverse effects and (particularly with zidovudine) cumulative toxicity that suggest that their long term benefits may not necessarily be as great as their short term prospects. Due to the pressing needs of the HIV-1 epidemic,social considerations and proven short term benefits,long term clinical trials of zidovudine and P. carinii prophylaxis employing untreated control groups are impossible. Thus,the long term benefits of these anti-AIDS therapies must be estimated from observational studies comparing those who choose to use those therapies and those who do not. Strong epidemiological biases and common statistical misanalyses of observational data occur,leading to seemingly contradictory results. On the basis of the aggregate of short term clinical data and long term observational studies,zidovudine therapy taken either before or after AIDS delays the date of death by 12 months. If zidovudine therapy is initiated before AIDS,it may delay the date of diagnosis of AIDS by 12 months. However,issues of cost effectiveness,detrimental effects and optimal time to begin zidovudine therapy remain unresolved. Limited observational study data suggest that P. carinii prophylaxis initiated before the onset of clinical AIDS will delay both the date of diagnosis of AIDS and the date of death by 9 months in North American men. The net benefits from P. carinii prophylaxis will be less in those who begin this treatment after a diagnosis of AIDS. Benefits from P. carinii prophylaxis will also probably be less in regions outside of North America,in particular underdeveloped countries,where P. carinii pneumonia is less common as an end-stage HIV-1-related illness.","Drugs,49(1): 20-36","USA",1995,"HIV,AIDS","Zidovudine",null,"Unknown","Cost and Resource Use,Mortality","Narrative Review"]
[32,"Horner,R. D.,et al. (1996). \"Predictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care.\" J Acquir Immune Defic Syndr Hum Retrovirol 12(4): 379-385.",null,"Horner,R. D.,et al.","Predictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care","To determine whether patient and hospital characteristics were significantly associated with variations in Pneumocystis carinii (PCP) care and outcomes,we analyzed the use of diagnostic tests,intensive care units (ICUs),anti-PCP medications for persons hospitalized with human immunodeficiency virus (HIV)-related PCP,and hospital discharge status. We conducted retrospective chart reviews of a cohort of 2,174 patients with PCP hospitalized in 1987-1990. Outcomes included process of care for PCP and in-hospital mortality rates. Persons with PCP who were more severely ill at admission were more likely to have early medical care,to receive care in an intensive care unit,and to die in hospital. After we adjusted for differences in this severity of illness,we noted that Medicaid patients,injection drug users (IDUs),and patients treated at VA or county hospitals were significantly less likely than others to have diagnostic bronchoscopies and that persons covered by Medicaid,with a previous diagnosis of acquired immunodeficiency syndrome (AIDS),who did not receive prior zidovudine (AZT) or who received care in a VA hospital had the highest chances of in-hospital death. Insurance and risk group characteristics,severity of illness,and hospital characteristics appear to be the most important determinants of the intensity and timing of medical care and outcomes among patients hospitalized with PCP.","J Acquir Immune Defic Syndr Hum Retrovirol,12(4): 379-385","USA",1996,"HIV,AIDS","Zidovudine",null,"Unknown","Cost and Resource Use,Mortality","Retrospective Observational"]
[33,"Hughes,W. T. (1998). \"Use of dapsone in the prevention and treatment of Pneumocystis carinii pneumonia: a review.\" Clin Infect Dis 27(1): 191-204.",null,"Hughes,W. T.","Use of dapsone in the prevention and treatment of Pneumocystis carinii pneumonia: a review","Dapsone,with or without trimethoprim or pyrimethamine,has strong anti-Pneumocystis carinii activity,as demonstrated by in vitro methods,animal studies,and clinical trials. The drug blocks folic acid synthesis of P. carinii by inhibition of dihydropteroate synthetase activity. Dapsone is efficiently absorbed (70%-80%) from the gastrointestinal tract,reaches peak serum concentration in 2-6 hours,and is adequately distributed to the fluid of the alveolar spaces. Synergistic effects against P. carinii are noted when trimethoprim is combined with dapsone. This combination is recommended for therapeutic use for P. carinii pneumonia (PCP) as an alternative for patients who cannot take trimethoprim-sulfamethoxazole (TMP-SMZ). Evidence from more than 40 studies of dapsone as prophylaxis for PCP in AIDS patients shows that dapsone,either alone or in combination with pyrimethamine,is as effective as aerosolized pentamidine or atovaquone but slightly less effective than TMP-SMZ. Adverse effects include rash,anemia,methemoglobinemia,agranulocytosis,and hepatic dysfunction. Desensitization can be accomplished with many cases. Dapsone is the most cost-effective prophylaxis currently available for PCP.","Clin Infect Dis,27(1): 191-204","USA",1998,"AIDS","Dapsone",null,"Unknown","Cost and Resource Use,Mortality","Narrative Review"]
[34,"Hughes,W. T.,et al. (1987). \"Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis.\" N Engl J Med 316(26): 1627-1632.",null,"Hughes,W. T.,et al.","Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis","We conducted a prospective,randomized clinical trial over a two-year period in patients with acute lymphocytic leukemia to assess the effectiveness of trimethoprim-sulfamethoxazole given on three consecutive days each week as compared with daily in the prevention of Pneumocystis carinii pneumonitis. P. carinii pneumonitis did not develop in any of 92 patients receiving the drug daily (30,602 patient-days) or in any of 74 who received it three consecutive days a week (27,329 patient-days),whereas the incidence of the infection expected without prophylaxis is 21 percent. One patient,excluded from both groups because of an adverse reaction to sulfonamides in the past,acquired P. carinii pneumonitis. Especially noteworthy was a difference in the occurrence of systemic mycoses,with 10 cases in the daily-treatment group and only 1 case in the three-days-a-week group (P = 0.024). No differences were observed in the rates of other infections or adverse effects associated with the drug. We conclude that trimethoprim-sulfamethoxazole is as effective given three days a week as it is given daily in the prevention of P. carinii pneumonitis and that the intermittent schedule has the advantages of less frequent fungal infections and lower cost. Intermittent chemoprophylaxis may be especially beneficial to certain patients who are unable to tolerate the daily doses.","N Engl J Med,316(26): 1627-1632","Unknown",1987,"Not Specified","Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT"]
[35,"Jacobson, L. P., et al. (1993). \"Changes in survival after acquired immunodeficiency syndrome (AIDS): 1984-1991.\" Am J Epidemiol 138(11): 952-964.",null,"Jacobson, L. P., et al.","Changes in survival after acquired immunodeficiency syndrome (AIDS): 1984-1991","In a prospective cohort of 2,647 human immunodeficiency virus type 1 (HIV-1) seropositive homosexual men enrolled in Baltimore, Chicago, Los Angeles, and Pittsburgh, 891 developed clinical acquired immunodeficiency syndrome (AIDS) between June 1984 and January 1992. Cox proportional hazards models were used to examine temporal trends in survival after AIDS for specific diagnoses, controlling for level of immunosuppression at diagnosis, age, race, and geographic location. Median survival time following AIDS onset increased from 11.6 months in 1984-1985 to 19.5 months in 1988-1989; for those diagnosed in 1990-1991, the median survival time dropped to 17.2 months. Trends in improved survival were diagnosis-specific. Survival after Pneumocystis carinii pneumonia consistently improved from 1984 to 1991 (p < 0.001). Compared with men diagnosed in 1984-1985, those diagnosed with P. carinii pneumonia in 1990-1991 had one-tenth the hazard of dying. For men with > or = 100 helper T-lymphocytes (CD4+ cells) when diagnosed with Kaposi's sarcoma, the relative hazards (95% confidence intervals) of dying after Kaposi's sarcoma were 0.8 (0.42-1.60) in 1986-1987, 0.7 (0.34-1.58) in 1988-1989, and 0.6 (0.19-1.61) in 1990-1991 compared with those diagnosed before 1986. Men with < 100 CD4+ cells when diagnosed with Kaposi's sarcoma did not demonstrate a consistent change in their subsequent survival. After a nonsignificant (p > 0.05) initial improvement in prognosis, there has not been a significant improvement in survival for men who presented with other opportunistic infections. Observed increases in overall survival probably relate to improved treatment of patients who develop P. carinii pneumonia. Limited improvement in survival following other AIDS diagnoses indicates the need for developing effective treatment against these diseases.","Am J Epidemiol, 138(11): 952-964","USA",1993,"AIDS",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort"]
[36,"Jensen, L., et al. (2010). \"Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania.\" BMC Infect Dis 10: 140.",null,"Jensen, L., et al.","Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania","BACKGROUND: In tuberculosis (TB) endemic parts of the world, patients with pulmonary symptoms are managed as \"smear-negative TB patients\" if they do not improve on a two-week presumptive, broad-spectrum course of antibiotic treatment even if they are TB microscopy smear negative. These patients are frequently HIV positive and have a higher mortality than smear-positive TB patients. Lack of access to diagnose Pneumocystis jirovecii pneumonia might be a contributing reason. We therefore assessed the prevalence of P. jirovecii by PCR in oral wash specimens among TB patients and healthy individuals in an HIV- and TB-endemic area of sub-Saharan Africa. METHODS: A prospective study of 384 patients initiating treatment for sputum smear-positive and smear-negative TB and 100 healthy household contacts and neighbourhood controls. DNA from oral wash specimens was examined by PCR for P. jirovecii. All patients delivered sputum for TB microscopy and culture. Healthy contacts and community controls were clinically assessed and all study subjects were HIV tested and had CD4 cell counts determined. Clinical status and mortality was assessed after a follow-up period of 5 months. RESULTS: 384 patients and 100 controls were included, 53% and 8% HIV positive respectively. A total number of 65 patients and controls (13.6%) were at definitive risk for PCP based on CD4 counts <200 cells per mm3 and no specific PCP prophylaxis. Only a single patient (0.3% of the patients) was PCR positive for P. jirovecii. None of the healthy household contacts or neighbourhood controls had PCR-detectable P. jirovecii DNA in their oral wash specimens regardless of HIV-status. CONCLUSIONS: The prevalence of P. jirovecii as detected by PCR on oral wash specimens was very low among TB patients with or without HIV and healthy individuals in Tanzania. Colonisation by P. jirovecii was not detected among healthy controls. The present findings may encourage diagnostic use of this non-invasive method.","BMC Infect Dis, 10(140","Tanzania",2010,"HIV,TB",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort"]
[37,"Kemper, C. A., et al. (1990). \"Low-dose dapsone prophylaxis of Pneumocystis carinii pneumonia in AIDS and AIDS-related complex.\" Aids 4(11): 1145-1148.",null,"Kemper, C. A., et al.","Low-dose dapsone prophylaxis of Pneumocystis carinii pneumonia in AIDS and AIDS-related complex","The efficacy, toxicity and cost of orally administered dapsone (50-100 mg/day) for prophylaxis of Pneumocystis carinii pneumonia (PCP) were evaluated in 30 patients with AIDS or AIDS-related complex (ARC). Six patients received primary and 24 secondary prophylaxis. Ten patients received a maximum dose of 100 mg/day and 20 a maximum of 50 mg/day for a median duration of 19 weeks; 22 of the 30 patients continue to receive prophylaxis as of May 1989. Four patients have died, none of pneumocystis infection. One patient with AIDS suffered a mild relapse while receiving 50 mg/day. Hematologic toxicity was mild and could not be definitively attributed to dapsone therapy; rash due to dapsone was documented in two patients. A review of 33 patients at our institution with a history of PCP who received no prophylaxis demonstrated seven relapses, three of which were fatal. Cost analysis revealed a significant advantage for oral dapsone over aerosolized pentamidine.","Aids, 4(11): 1145-1148","USA",1990,"AIDS","Dapsone",null,"Unknown","Mortality,Cost and Resource Use,Cross-Sectional","Retrospective Observational"]
[38,"Low, A., et al. (2016). \"Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.\" Clin Infect Dis 62(12): 1595-1603.",null,"Low, A., et al.","Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis","BACKGROUND: To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected adults in low- and middle-income countries (LMICs). METHODS: Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count >/=200 cells/microL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case. RESULTS: We identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%-91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval [CI], 828 032-874 853), with cost savings of $46.7 million (95% CI, $43.8-$49.4 million). CONCLUSIONS: There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted.","Clin Infect Dis, 62(12): 1595-1603","UK,Switzerland,Canada,USA",2016,"HIV,AIDS","Antiretroviral therapy",null,"Unknown","Mortality,Epidemiology","Systematic Review"]
[39,"Lundgren, J. D., et al. (1995). \"Changes in survival over time after a first episode of Pneumocystis carinii pneumonia for European patients with acquired immunodeficiency syndrome. Multicentre Study Group on AIDS in Europe.\" Arch Intern Med 155(8): 822-828.",null,"Lundgren, J. D., et al.","Changes in survival over time after a first episode of Pneumocystis carinii pneumonia for European patients with acquired immunodeficiency syndrome. Multicentre Study Group on AIDS in Europe","BACKGROUND: Factors associated with improved survival over time for patients with the acquired immunodeficiency syndrome (AIDS) who have Pneumocystis carinii pneumonia at diagnosis are not clearly defined. METHODS: An inception cohort of 2533 patients with AIDS, diagnosed from 1979 to 1989, from 52 centers in 17 European countries was studied. Survival 3 months and 3 years after diagnosis was estimated by Kaplan-Meier life tables. Independent predictors of survival were analyzed by construction of Cox proportional hazards models. RESULTS: Patients in whom AIDS and P carinii pneumonia had been diagnosed before 1988 had a poorer 3-month (ie, short-term) survival, whereas the survival 1 and 2 years after P carinii pneumonia was lower only for patients whose disease was diagnosed before 1987 compared with those with more recent diagnoses. Other variables associated with poorer outcome were greater age, infection via blood transfusion, diagnosis made in south Europe, and coexisting illnesses. After controlling for these prognostic markers in multivariate analysis, improvement in survival over time was still evident. For patients who survived the P carinii pneumonia episode, both zidovudine and secondary prophylaxis for P carinii pneumonia initiated around the time of diagnosis were associated with improved survival, and, after controlling for these treatment variables, no statistically significant improvement in survival over time was observed. CONCLUSIONS: Survival after an episode of P carinii pneumonia has improved within recent years. Increased awareness of early symptoms of P carinii pneumonia and better treatment of the pneumonia may have led to improvement in short-term survival over time, whereas the introduction of zidovudine and increased use of secondary P carinii pneumonia prophylaxis may have resulted in the recent increase in survival 1 and 2 years after the diagnosis. However, 3-year survival remained unchanged over time, implying that the underlying human immunodeficiency virus infection and other complications are not effectively controlled.","Arch Intern Med, 155(8): 822-828","Europe",1995,"AIDS","Zidovudine",null,"Unknown","Mortality,Epidemiology,Cross-Sectional","Retrospective Observational"]
[40,"Machen, H. E., et al. (2015). \"Outcomes of Patients with Respiratory Distress Treated with Bubble CPAP on a Pediatric Ward in Malawi.\" J Trop Pediatr 61(6): 421-427.",null,"Machen, H. E., et al.","Outcomes of Patients with Respiratory Distress Treated with Bubble CPAP on a Pediatric Ward in Malawi","OBJECTIVE: To describe the outcomes of infants and young children with respiratory distress when treated with a novel, low-cost, stand-alone bubble Continuous Positive Airway Pressure (bCPAP) system in a resource-limited setting. METHODS: A non-randomized, convenience sample study in a pediatric unit in Blantyre, Malawi, 2013. Patients weighing </=10 kg with respiratory distress were eligible. We compared outcomes for patients with bronchiolitis, pneumonia and Pneumocystis jiroveci pneumonia (PJP) after treatment with bCPAP. RESULTS: Seventy percent of patients treated with bCPAP survived. Outcomes were best for patients with bronchiolitis and worst for those with PJP. Most survivors (80%) showed improvement within 24 h. All treating physicians found bCPAP useful, leading to a change in practice. CONCLUSIONS: Bubble CPAP was most beneficial to patients with bronchiolitis. Children, who were going to get well, tended to get well quickly. Physicians believed the bCPAP system provided a higher level of care than nasal oxygen.","J Trop Pediatr, 61(6): 421-427","Malawi",2015,"Not Specified","Bubble CPAP",null,"Children","Mortality,Cross-Sectional","Prospective Cohort"]
[41,"Mansharamani, N. G., et al. (2000). \"Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states.\" Chest 118(3): 704-711.",null,"Mansharamani, N. G., et al.","Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states","STUDY OBJECTIVES: Encompassing periods preceding and following major advances in the diagnosis and management of HIV-related Pneumocystis carinii pneumonia (PCP), the purpose of this study was to determine whether management and outcome patterns of non-HIV PCP parallel the management and outcomes of AIDS-related PCP. DESIGN: Retrospective review of medical records. SETTING: A 375-bed tertiary-care urban teaching hospital and referral center. PATIENTS: All adult patients with morphologically confirmed PCP from 1985 to 1995. MEASUREMENTS AND RESULTS: From 1985 to 1995, 638 confirmed cases of PCP were identified, including 605 cases in 442 HIV-positive persons (HIV + PCP), and 33 cases in 33 non-HIV patients (non-HIV PCP). For HIV + PCP cases, a peak of 104 cases occurred in 1987, with a gradual decline to 23 in 1995. The proportion of cases requiring hospitalization declined from a peak of 91.6% in 1987 to a low of 51.6% in 1992. ICU admission was required for 6.3 to 8.2%, and mechanical ventilation for 4.7 to 5.7%. Overall mortality improved from 11.7 to 6.6%, although mortality for intubated patients remained at 50 to 60%. For the non-HIV PCP cases, 97% occurred from 1989 to 1995 with similar annual frequency, 97% required hospitalization, 69% required ICU admission, and 66% required intubation. Overall mortality was 39%, and mortality for intubated patients was 59%. CONCLUSIONS: Despite major advances in diagnosis and management, PCP remains a significant problem in non-HIV-infected patients, and respiratory failure remains associated with a high mortality rate for patients with both HIV + PCP and non-HIV PCP.","Chest, 118(3): 704-711","USA",2000,"HIV,Immunocompromised",null,null,"Adults","Mortality,Cross-Sectional","Retrospective Observational"]
[42,"May, T., et al. (1994). \"Trimethoprim-sulfamethoxazole versus aerosolized pentamidine for primary prophylaxis of Pneumocystis carinii pneumonia: a prospective, randomized, controlled clinical trial. LFPMI Study Group. Ligue Francaise de Prevention des Maladies Infectieuses.\" J Acquir Immune Defic Syndr 7(5): 457-462.",null,"May, T., et al.","Trimethoprim-sulfamethoxazole versus aerosolized pentamidine for primary prophylaxis of Pneumocystis carinii pneumonia: a prospective, randomized, controlled clinical trial. LFPMI Study Group. Ligue Francaise de Prevention des Maladies Infectieuses","The objective was to compare the efficacy and tolerance of monthly aerosolized pentamidine versus trimethoprim-sulfamethoxazole (TMP-SMX) to prevent the first episode of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients. In an open, prospective, randomized multicentric clinical trial, HIV-infected patients (n = 214) with CD4 cell counts < 200/mm3 or 20% without a history of PCP or cerebral toxoplasmosis were randomized to receive for at least 2 years aerosolized pentamidine (300 mg monthly) or low-dose daily TMP-SMX (400-80 mg). The mean follow-up was 578 days. The two groups (except for gender) were homogeneous for age, risk group for HIV infection, initial CD4+ lymphocyte count, and mean follow-up. The PCP rate per year of observation using an intent-to-treat analysis was 3.1% and 1.3% in the groups treated with pentamidine and TMP-SMX, respectively (p > 0.05). Moderate or severe clinical and biological side effects were observed in five patients on pentamidine and 33 on TMP-SMX (p < 0.05). Nineteen episodes of cerebral toxoplasmosis were diagnosed during the study. The analysis showed no significant difference in time of development of toxoplasmosis, but only one patient was actually treated with TMP-SMX. Survival was not significantly different in the two groups. Low-dose daily TMP-SMX or monthly aerosolized pentamidine effectively prevented a first episode of PCP in HIV-infected patients, but aerosolized pentamidine was better tolerated. However, TMP-SMX is less costly and should have a preventive effect for toxoplasmosis.","J Acquir Immune Defic Syndr, 7(5): 457-462","France",1994,"HIV","Trimethoprim-sulfamethoxazole,Pentamidine",null,"Unknown","Mortality","RCT"]
[43,"Metersky, M. L., et al. (1992). \"Lack of utility of bronchial brush biopsy in patients infected with the human immunodeficiency virus.\" Chest 101(3): 680-683.",null,"Metersky, M. L., et al.","Lack of utility of bronchial brush biopsy in patients infected with the human immunodeficiency virus","While bronchoalveolar lavage has been shown to be more sensitive than brush biopsy (BB) for the diagnosis of Pneumocystis carinii pneumonia in AIDS patients, some have reported that BB occasionally is positive in spite of a negative BAL. Many bronchoscopists, therefore, continue to perform routine BB when doing bronchoscopy on AIDS patients. We performed a retrospective study of all fiberoptic bronchoscopies done on human immunodeficiency virus-infected patients over a one-year period at our institution to determine if the use of BB added to the diagnostic yield of bronchoscopy over that of BAL alone. Of 84 bronchoscopies in which BB was performed in addition to BAL, BB yielded no diagnoses that were not obtained by BAL. Brush biopsy added approximately $400 to the cost of bronchoscopy. We conclude that BB should not be routinely done when performing bronchoscopy on HIV-infected patients.","Chest, 101(3): 680-683","USA",1992,"AIDS",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Retrospective Observational"]
[44,"Narasimha, P. D., et al. (2004). \"Role of multiple induced sputum examination in the diagnosis of Pneumocystis carinii pneumonia.\" Southeast Asian J Trop Med Public Health 35(3): 702-704.",null,"Narasimha, P. D., et al.","Role of multiple induced sputum examination in the diagnosis of Pneumocystis carinii pneumonia","We evaluated the usefulness of repeated nebulized saline induced sputum examinations among 60 HIV infected patients clinically suspected to have Pneumocystis carinii pneumonia (PCP). We found that the first sample was positive for 15 episodes (21.4%); the second sample was positive in 33 episodes (47.1%); the third sample was positive in 22 episodes (31.4%). Repeated nebulized saline induced sputum examination imporved the yield of Pneumocystis carinii and enhanced the sensitivity of a positive result. This technique is simple, cost-effective, non-invasive, and reliable. We recommend the examination of multiple induced samples of nebulized saline induced sputum in all HIV infected patients with suspected PCP. This recommendation may decrease the need for invasive procedures.","Southeast Asian J Trop Med Public Health, 35(3): 702-704","India",2004,"HIV",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Clinical Study"]
[45,"Nassar, A., et al. (2006). \"Utility of reflex Gomori methenamine silver staining for Pneumocystis jirovecii on bronchoalveolar lavage cytologic specimens: a review.\" Diagn Cytopathol 34(11): 719-723.",null,"Nassar, A., et al.","Utility of reflex Gomori methenamine silver staining for Pneumocystis jirovecii on bronchoalveolar lavage cytologic specimens: a review","Pneumocystis jiroveci (Pj; formerly Pneumocystis carinii) is an opportunistic pathogen causing life-threatening pneumonia (Pneumocystis pneumonia) in immunosuppressed individuals. Its diagnosis is dependent on identification in bronchoalveolar lavage (BAL) specimens. Gomori's methenamine silver nitrate (GMS) stain has been advocated to highlight the organisms in BAL specimens. This study was performed to determine the utility of reflex GMS staining on all BAL specimens for identifying Pj.All BAL specimens from years 2000 to 2004 were processed as cytospins and stained with Papanicolaou (Pap) and GMS stains. A total of 2,984 BAL specimens were identified. A total of 116 (3.9% of total BAL) BAL specimens were diagnostic of Pj. The diagnostic specimens were grouped as follows: 103 (88.8% of total positive cases) Pj identified with both Pap and GMS staining; 11 (9.5% of total positive cases) Pj identified only with Pap staining; and 2 (1.7% of total positive cases) Pj identified only with GMS staining. In conclusion, the prevalence of Pj in BAL specimens is 3.9%, which can be attributed to improved management of immunocompromised patients. Performing reflex GMS staining on all BAL specimens does not improve the diagnostic identification of Pj since the majority (98.3%) of diagnoses can be rendered on Pap stained slides. A cost analysis for GMS staining on 2,879 GMS-negative BAL specimens was estimated at $143,950. Thus, from diagnostic and cost benefit perspectives, GMS staining can be recommended only on cases where Pap stain is negative, and the clinical presentation is consistent with Pneumocystis pneumonia.","Diagn Cytopathol, 34(11): 719-723","USA",2006,"Not Specified",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Narrative Review"]
[46,"Nicolau, D. P., et al. (1996). \"Pharmacoeconomics of Pneumocystis carinii pneumonia in HIV-infected and HIV-noninfected patients.\" Pharmacoeconomics 10(1): 72-78.",null,"Nicolau, D. P., et al.","Pharmacoeconomics of Pneumocystis carinii pneumonia in HIV-infected and HIV-noninfected patients","Despite the proven effectiveness of Pneumocystis carinii pneumonia (PCP) prophylaxis in both HIV-infected and HIV-noninfected patients, PCP remains an important cause of serious pulmonary infection. Because PCP is a frequent event requiring inpatient admission at our institution, we conducted a study to define the pharmacoeconomics of this infection and the incidence of adverse events associated with anti-PCP therapy. In a retrospective review, 133 patients (101 HIV-positive, 32 HIV-negative) with documented PCP were identified. Significant differences in age, initial arterial oxygen tension (paO2), intensive care unit admission and mortality were evident between HIV-infected and non-HIV-infected patients; however, there were no differences in the duration of hospitalisation or the duration of anti-PCP therapy. The incidence of biochemical abnormalities was similar between the groups. Leucopenia occurred at an incidence of 52 and 31%, while thrombocytopenia occurred at a rate of 7 and 44%, in HIV-positive and HIV-negative patients, respectively. Drug toxicity or treatment failure necessitated a change of therapy in 43% of HIV-positive and 59% of HIV-negative patients. PCP treatment cost, pharmacy cost, hospital cost and net loss (i.e. the difference between hospital cost and reimbursement) were all significantly greater in HIV-negative than in HIV-positive patients. The duration of anti-PCP therapy and the hospital cost for cotrimoxazole (trimethoprim-sulfamethoxazole)- and pentamidine-treated patients were similar, although the treatment cost and pharmacy cost were statistically different in favour of cotrimoxazole. Overall, cotrimoxazole is an inexpensive treatment option. However, the high incidence of adverse events attributed to this agent often necessitates a change to a more costly therapy.","Pharmacoeconomics, 10(1): 72-78","USA",1996,"HIV","Trimethoprim-sulfamethoxazole,Pentamidine",null,"Unknown","Cross-Sectional,Mortality,Cost and Resource Use","Retrospective Observational"]
[47,"Novak, R. M., et al. (2012). \"Immune reconstitution inflammatory syndrome: incidence and implications for mortality.\" Aids 26(6): 721-730.",null,"Novak, R. M., et al.","Immune reconstitution inflammatory syndrome: incidence and implications for mortality","OBJECTIVE: To describe incidence of immune reconstitution inflammatory syndrome (IRIS) and its association with mortality in a large multisite US HIV-infected cohort applying an objective, comprehensive definition. DESIGN: We studied 2,610 patients seen during 1996-2007 who initiated or resumed highly active combination antiretroviral therapy (cART) and, during the next 6 months, demonstrated a decline in plasma HIV-RNA viral load of at least 0.5 log(10) copies/ml or an increase of at least 50% in CD4 cell count per microliter. We defined IRIS as the diagnosis of a type B or C condition [as per the Centers for Disease Control and Prevention (CDC) 1993 AIDS case definition] or any new mucocutaneous disorder during this same 6-month period. METHODS: We assessed the incidence of IRIS and evaluated risk factors for IRIS using conditional logistic regression and for all-cause mortality using proportional hazards models. RESULTS: We identified 370 cases of IRIS (in 276 patients). Median and nadir CD4 cell counts at cART initiation were 90 and 43 cells/mul, respectively; median viral load was 2.7 log(10) copies/ml. The most common IRIS-defining diagnoses were candidiasis (all forms), cytomegalovirus infection, disseminated Mycobacterium avium intracellulare, Pneumocystis pneumonia, varicella zoster, Kaposi's sarcoma and non-Hodgkin lymphoma. Only one case of Mycobacterium tuberculosis was observed. IRIS was independently associated with CD4 cell count less than 50 cells/mul vs. at least 200 cells/mul [odds ratio (OR) 5.0] and a viral load of at least 5.0 log(10) copies vs. less than 4.0 log(10) copies (OR 2.3). IRIS with a type B-defining or type C-defining diagnosis approximately doubled the risk for all-cause mortality. CONCLUSION: In this large US-based HIV-infected cohort, IRIS occurred in 10.6% of patients who responded to effective ART and contributed to increased mortality.","Aids, 26(6): 721-730","USA",2012,"HIV",null,null,"Unknown","Mortality,Cross-Sectional","Retrospective Observational"]
[48,"Okafor, P. N., et al. (2015). \"Cost-effectiveness of Prophylaxis Against Pneumocystis jiroveci Pneumonia in Patients with Crohn's Disease.\" Dig Dis Sci 60(12): 3743-3755.",null,"Okafor, P. N., et al.","Cost-effectiveness of Prophylaxis Against Pneumocystis jiroveci Pneumonia in Patients with Crohn's Disease","BACKGROUND: Emerging evidence suggests that Pneumocystis jiroveci pneumonia is occurring more frequently in Crohn's disease patients on immunosuppressive medications, especially corticosteroids. Considering its excess mortality and the efficacy of chemoprophylaxis in reducing P. jiroveci pneumonia in acquired immunodeficiency syndrome, there is debate without consensus on the need for chemoprophylaxis in Crohn's disease patients on corticosteroids. AIMS: We sought to address this debate using insights from simulation modeling. METHODS: We used a Markov microsimulation model to simulate the natural history of Crohn's disease in 1 million virtual patients receiving appropriate care and who faced P. jiroveci pneumonia risks that varied with corticosteroid use. We examined several chemoprophylaxis strategies and compared their population-level economic and clinical impact using various indices including costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios. We also performed several nested probabilistic sensitivity analyses to estimate the health and economic impact of chemoprophylaxis in patients on triple immunosuppressive therapy. RESULTS: At the current PJP incidence, no PJP chemoprophylaxis was the preferred strategy from a population perspective. Considered chemoprophylactic strategies led to higher average costs and fewer P. jiroveci pneumonia cases. However, they also led to lower average quality-adjusted life expectancy and were thus dominated. Nevertheless, these alternative strategies became preferred with progressively higher risks of P. jiroveci pneumonia. Our results also suggest that PJP chemoprophylaxis may be cost-effective in patients on triple immunosuppressive therapy. CONCLUSION: Our findings support a case-by-case consideration of P. jiroveci pneumonia chemoprophylaxis in Crohn's disease patients receiving corticosteroids.","Dig Dis Sci, 60(12): 3743-3755","USA",2015,"Crohn's Disease","Prophylaxis",null,"Unknown","Economic Model,Mortality","Observational"]
[49,"Parada, J. P., et al. (2003). \"Relationship between health insurance and medical care for patients hospitalized with human immunodeficiency virus-related Pneumocystis carinii pneumonia, 1995-1997: Medicaid, bronchoscopy, and survival.\" Clin Infect Dis 37(11): 1549-1555.",null,"Parada, J. P., et al.","Relationship between health insurance and medical care for patients hospitalized with human immunodeficiency virus-related Pneumocystis carinii pneumonia, 1995-1997: Medicaid, bronchoscopy, and survival","In the late 1980s, Medicaid-insured human immunodeficiency virus (HIV)-infected patients with Pneumocystis carinii pneumonia (PCP) were 40% less likely to undergo diagnostic bronchoscopy and 75% more likely to die than were privately insured patients, whereas rates of use of other, less resource-intensive aspects of PCP care were similar. We reviewed 1395 medical records at 59 hospitals in 6 cities for the period 1995-1997 to examine the impact of insurance status on PCP-related care. Medicaid patients were only one-half as likely to undergo diagnostic bronchoscopy as were privately insured patients, yet we found no evidence that mortality was greater among patients who received empirical treatment. The bronchoscopy rates were primarily related to patients' personal insurance status. A weaker hospital-level effect was seen that was related to hospitals' Medicaid/private insurance case mix ratios. The situation has evolved from one in which Medicaid coverage was associated with underuse of bronchoscopy and poorer survival among empirically treated persons with HIV-related PCP to one in which empirical therapy is effective in treating this disease and expensive diagnostic procedures may be overused for privately insured patients.","Clin Infect Dis, 37(11): 1549-1555","USA",2003,"HIV",null,null,"Unknown","Cross-Sectional,Mortality","Retrospective Observational"]
[50,"Rizzardi, G. P., et al. (1996). \"Risks and benefits of aerosolized pentamidine and cotrimoxazole in primary prophylaxis of Pneumocystis carinii pneumonia in HIV-1-infected patients: a two-year Italian multicentric randomized controlled trial. The Italian PCP Study Group.\" J Infect 32(2): 123-131.",null,"Rizzardi, G. P., et al.","Risks and benefits of aerosolized pentamidine and cotrimoxazole in primary prophylaxis of Pneumocystis carinii pneumonia in HIV-1-infected patients: a two-year Italian multicentric randomized controlled trial. The Italian PCP Study Group","We randomized 220 HIV-1-infected subjects to receive aerosolized pentamidine (300 mg/4 weeks) or orally trimethoprim-sulfamethoxazole (320-1600 mg/day) for primary prophylaxis of Pneumocystis carinii pneumonia (PCP), and evaluated PCP and toxoplasmic encephalitis (TE) occurrence and survival. Patients developing toxicity switched to the other regimen. Analysis was on intention-to-treat. At 1 year of study, we observed in the pentamidine group a non-significant excess of PCP (4 vs. 1) and TE (7 vs. 3), and a significant increased death rate (15 vs. 2). After 2 years, no significant differences were observed: adjusted RR estimates for pentamidine vs. cotrimoxazole were 1.20 (95% CI, 0.33-4.37) for PCP (6 cases vs. 5), 1.23 (95% CI, 0.46-3.29) for TE (10 vs. 8) and 1.52 (95% CI, 0.83-2.79) for death (30 vs. 18). Crossovers were more frequent in the cotrimoxazole group (41 vs. 4, P < 0.001). Aerosolized pentamidine and cotrimoxazole were equally effective in preventing PCP, and no major differences were observed in TE occurrence and survival after 2 years follow-up.","J Infect, 32(2): 123-131","Italy",1996,"HIV","Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT"]
[51,"Robert-Gangneux, F., et al. (2014). \"Diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients by real-time PCR: a 4-year prospective study.\" J Clin Microbiol 52(9): 3370-3376.",null,"Robert-Gangneux, F., et al.","Diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients by real-time PCR: a 4-year prospective study","Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection in immunocompromised patients. Quantitative real-time PCR (qPCR) is more sensitive than microscopic examination for the detection of P. jirovecii but also detects colonized patients. Hence, its positive predictive value (PPV) needs evaluation. In this 4-year prospective observational study, all immunocompromised patients with acute respiratory symptoms who were investigated for PCP were included, totaling 659 patients (814 bronchoalveolar lavage fluid samples). Patients with negative microscopy but positive qPCR were classified through medical chart review as having retained PCP, possible PCP, or colonization, and their clinical outcomes were compared to those of patients with microscopically proven PCP. Overall, 119 patients were included for analysis, of whom 35, 41, and 43 were classified as having retained PCP, possible PCP, and colonization, respectively. The 35 patients with retained PCP had clinical findings similar to those with microscopically proven PCP but lower fungal loads (P < 0.001) and were mainly non-HIV-infected patients (P < 0.05). Although the mean amplification threshold was higher in colonized patients, it was not possible to determine a discriminant qPCR cutoff. The PPV of qPCR in patients with negative microscopy were 29.4% and 63.8% when considering retained PCP and retained plus possible PCP, respectively. Patients with possible PCP had a higher mortality rate than patients with retained PCP or colonization (63% versus 3% and 16%, respectively); patients who died had not received co-trimoxazole. In conclusion, qPCR is a useful tool to diagnose PCP in non-HIV patients, and treatment might be better targeted through a multicomponent algorithm including both clinical/radiological parameters and qPCR results.","J Clin Microbiol, 52(9): 3370-3376","France",2014,"HIV",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort"]
[52,"Rossi, M. R., et al. (1987). \"Prospective randomized comparison of two prophylactic regimens with trimethoprim-sulfamethoxazole in leukemic children: a two year study.\" Eur J Cancer Clin Oncol 23(11): 1679-1682.",null,"Rossi, M. R., et al.","Prospective randomized comparison of two prophylactic regimens with trimethoprim-sulfamethoxazole in leukemic children: a two year study","Between 1 July 1984 and 30 June 1986 all children treated for acute hematologic malignancy at our center were randomized to receive continuous (group A) or intermittent (3 days/week, group B) prophylaxis with trimethoprim-sulfamethoxazole (5-25 mg/kg/day/p.o.) against interstitial pneumonia with the aim of investigating if an intermittent regimen is as effective as and less toxic than a continuous regimen. The number of severe infections (group A, 17; group B, 21) and side-effects (group A, 30; group B, 34) was similar in the two groups, and compliance was also similar. We conclude therefore that neither regimen offers advantages over the other and the decision which to use should be based on cost (where regimen B has the advantage) and the children's and parents' preferences and compliance.","Eur J Cancer Clin Oncol, 23(11): 1679-1682","Italy",1987,"Not Specified","Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT"]
[53,"Roux, A., et al. (2014). \"Pneumocystis jirovecii pneumonia in patients with or without AIDS, France.\" Emerg Infect Dis 20(9): 1490-1497.",null,"Roux, A., et al.","Pneumocystis jirovecii pneumonia in patients with or without AIDS, France","Pneumocystis jirovecii pneumonia (PCP) in patients without AIDS is increasingly common. We conducted a prospective cohort study of consecutive patients with proven PCP; of 544 patients, 223 (41%) had AIDS (AIDS patients) and 321 (59%) had other immunosuppressive disorders (non-AIDS patients). Fewer AIDS than non-AIDS patients required intensive care or ventilation, and the rate of hospital deaths--17.4% overall--was significantly lower for AIDS versus non-AIDS patients (4% vs. 27%; p<0.0001). Multivariable analysis showed the odds of hospital death increased with older age, receipt of allogeneic bone marrow transplant, immediate use of oxygen, need for mechanical ventilation, and longer time to treatment; HIV-positive status or receipt of a solid organ transplant decreased odds for death. PCP is more often fatal in non-AIDS patients, but time to diagnosis affects survival and is longer for non-AIDS patients. Clinicians must maintain a high index of suspicion for PCP in immunocompromised patients who do not have AIDS.","Emerg Infect Dis, 20(9): 1490-1497","France",2014,"AIDS,Immunocompromised",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort"]
[54,"Saah, A. J., et al. (1995). \"Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Multicenter AIDS Cohort Study.\" Jama 273(15): 1197-1202.",null,"Saah, A. J., et al.","Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Multicenter AIDS Cohort Study","OBJECTIVE: To identify clinical and epidemiological factors associated with failure of Pneumocystis carinii pneumonia (PCP) prophylaxis in those receiving primary and secondary prophylaxis. DESIGN: Longitudinal cohort study of participants infected with human immunodeficiency virus type 1 in the Multicenter AIDS Cohort Study who used PCP prophylaxis regimens after their T-helper lymphocyte counts had decreased to less than 0.200 x 10(9)/L (200/microL). MAIN OUTCOME MEASURE: Occurrence or recurrence of PCP. RESULTS: A total of 476 participants reported taking one or more of the following regimens: trimethoprim-sulfamethoxazole (TMP-SMX), dapsone, and/or aerosolized pentamidine--367 as primary prophylaxis and 109 as secondary prophylaxis after a previous episode of PCP. A total of 92 (20%) developed PCP despite prophylaxis. The mean failure rates per person-year of follow-up were 16.0% for those receiving primary prophylaxis and 12.1% for those receiving secondary prophylaxis (P = .19). Median times to death after initiation of primary or secondary prophylaxis were 2.0 and 1.2 years, respectively. The main predictor for failure of PCP prophylaxis was profound T-helper lymphocytopenia; 86% of failures occurred after T-helper cell counts decreased to less than 0.075 x 10(9)/L and 76% occurred after counts decreased to less than 0.050 x 10(9)/L. In multivariate time-dependent analysis, when compared with counts between 0.100 x 10(9)/L and 0.200 x 10(9)/L, the risk ratio for failure with counts less than 0.050 x 10(9)/L was 2.90 (P < .001). Once T-helper cell counts were considered, fever was the only other health status indicator that predicted subsequent PCP (ie, a time-dependent risk ratio of 2.22; P = .01). Use of TMP-SMX as the prophylaxis regimen was protective but did not eliminate failure (ie, a time-dependent risk ratio of 0.55; P = .03). CONCLUSIONS: These findings strongly support identifying improved methods of PCP prophylaxis once T-helper cell counts decrease to less than 0.075 x 10(9)/L or 0.100 x 10(9)/L. Given this severe degree of immunosuppression, an inherently more effective regimen against P carinii is required.","Jama, 273(15): 1197-1202","USA",1995,"AIDS","Trimethoprim-sulfamethoxazole,Dapsone,Pentamidine",null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort"]
[55,"Samuel, C. M., et al. (2011). \"Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study.\" BMC Infect Dis 11: 329.",null,"Samuel, C. M., et al.","Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study","BACKGROUND: Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in HIV-infected African children. Microbiologic diagnosis relies predominantly on silver or immunofluorescent staining of a lower respiratory tract (LRT) specimens which are difficult to obtain in children. Diagnosis on upper respiratory tract (URT) specimens using PCR has been reported useful in adults, but data in children are limited. The main objectives of the study was (1) to compare the diagnostic yield of PCR with immunofluorescence (IF) and (2) to investigate the usefulness of upper compared to lower respiratory tract samples for diagnosing PCP in children. METHODS: Children hospitalised at an academic hospital with suspected PCP were prospectively enrolled. An upper respiratory sample (nasopharyngeal aspirate, NPA) and a lower respiratory sample (induced sputum, IS or bronchoalveolar lavage, BAL) were submitted for real-time PCR and direct IF for the detection of Pneumocystis jirovecii. A control group of children with viral lower respiratory tract infections were investigated with PCR for PCP. RESULTS: 202 children (median age 3.3 [inter-quartile range, IQR 2.2 - 4.6] months) were enrolled. The overall detection rate by PCR was higher than by IF [180/349 (52%) vs. 26/349 (7%) respectively; p < 0.0001]. PCR detected more infections compared to IF in lower respiratory tract samples [93/166 (56%) vs. 22/166 (13%); p < 0.0001] and in NPAs [87/183 (48%) vs. 4/183 (2%); p < 0.0001]. Detection rates by PCR on upper (87/183; 48%) compared with lower respiratory tract samples (93/166; 56%) were similar (OR, 0.71; 95% CI, 0.46 - 1.11). Only 2/30 (6.6%) controls were PCR positive. CONCLUSION: Real-time PCR is more sensitive than IF for the detection of P. jirovecii in children with PCP. NPA samples may be used for diagnostic purposes when PCR is utilised. Wider implementation of PCR on NPA samples is warranted for diagnosing PCP in children.","BMC Infect Dis, 11(329","South Africa",2011,"HIV",null,null,"Children","Diagnostic Research","Prospective Cohort"]
[56,"Schneider, M. M., et al. (1992). \"A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group.\" N Engl J Med 327(26): 1836-1841.",null,"Schneider, M. M., et al.","A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group","BACKGROUND: Primary prophylaxis against Pneumocystis carinii pneumonia (PCP) is recommended for patients with human immunodeficiency virus (HIV) infection if their CD4 cell counts are below 200 per cubic millimeter (0.2 x 10(9) per liter). Either aerosolized pentamidine or trimethoprim-sulfamethoxazole (co-trimoxazole) is commonly prescribed for prophylaxis, but the relative efficacy and toxicity of these agents are unknown. METHODS: We conducted a multicenter trial involving 215 HIV-infected patients with no history of PCP but with CD4 cell counts below 200 per cubic millimeter. The patients were randomly assigned to one of three regimens: aerosolized pentamidine once a month, 480 mg of trimethoprim-sulfamethoxazole once a day (80 mg of trimethoprim and 400 mg of sulfamethoxazole), or 960 mg of trimethoprim-sulfamethoxazole once a day (160 mg and 800 mg, respectively). The cumulative incidence of PCP was estimated by Kaplan-Meier survival analysis. RESULTS: After a mean follow-up of 264 days, 6 of the 71 patients in the pentamidine group had a confirmed first episode of PCP (11 percent), whereas none of the 142 patients in the two trimethoprim-sulfamethoxazole groups had PCP (P = 0.002). However, adverse events that required discontinuation of the medication were much more frequent in the trimethoprim-sulfamethoxazole groups (17 and 18 patients) than in the pentamidine group (2 patients). The adverse reactions occurred significantly sooner in the group given 960 mg of trimethoprim-sulfamethoxazole than in the group given 480 mg (mean time, 16 vs. 57 days; P = 0.02). CONCLUSIONS: For patients with HIV infection, trimethoprim-sulfamethoxazole taken once a day is more effective as primary prophylaxis against PCP than aerosolized pentamidine administered once a month, although adverse drug reactions are more frequent with trimethoprim-sulfamethoxazole.","N Engl J Med, 327(26): 1836-1841","Netherlands",1992,"HIV","Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT"]
[57,"Schwarcz, S. K., et al. (1997). \"Prevention of Pneumocystis carinii pneumonia: who are we missing?\" Aids 11(10): 1263-1268.",null,"Schwarcz, S. K., et al.","Prevention of Pneumocystis carinii pneumonia: who are we missing?","OBJECTIVE: To obtain population-based information on the characteristics of persons who were not receiving chemoprophylaxis against Pneumocystis carinii pneumonia (PCP) by examining the use of primary and secondary PCP prophylaxis among San Francisco residents whose AIDS-defining opportunistic illness was PCP in 1993. DESIGN: Retrospective medical record review. SETTING: Medical charts were obtained from San Francisco hospitals and outpatient facilities at which AIDS patients received their initial AIDS diagnosis. PARTICIPANTS: San Francisco residents whose AIDS-defining opportunistic illness was PCP in 1993. MAIN OUTCOME MEASURES: Use of primary and secondary PCP prophylaxis. RESULTS: Of the 326 eligible patients, 35% received primary PCP prophylaxis. Non-whites were significantly less likely to have received primary PCP prophylaxis than white patients [22 versus 40%, respectively; odds ratio (OR), 0.49; 95% confidence intervals (CI), 0.28-0.87]. Uninsured individuals-were also less likely to have received primary PCP prophylaxis than those with insurance (18 versus 41%; OR, 0.35; 95% CI, 0.17-0.73). The sociodemographic characteristics of patients who did and did not receive secondary PCP prophylaxis did not differ significantly. The most frequently cited reasons for not receiving primary PCP prophylaxis were that patients were unaware of their infection with HIV or were not receiving regular medical care. CONCLUSIONS: Barriers to receipt of PCP prophylaxis exist and are resulting in cases of preventable disease and unnecessary medical costs. Interventions to increase counseling, testing, and referral to medical care for persons at high risk for HIV infection are needed.","Aids, 11(10): 1263-1268","USA",1997,"AIDS","Prophylaxis",null,"Unknown","Cost and Resource Use,Mortality,Cross-Sectional","Retrospective Observational"]
[58,"Strenge, K. S., et al. (2015). \"Utility of reflexive gomori methenamine silver and Acid-fast bacillus staining on bronchoalveolar lavage specimens.\" Lab Med 46(1): 4-7.",null,"Strenge, K. S., et al.","Utility of reflexive gomori methenamine silver and Acid-fast bacillus staining on bronchoalveolar lavage specimens","OBJECTIVE: Reflexive testing of bronchoalveolar lavage (BAL) specimens with Gomori methenamine silver (GMS) and acid-fast bacillus (AFB) stains is not routinely performed by most institutions. Instead, these stains are usually ordered to evaluate for the presence of fungal elements and/or acid-fast organisms if initial histopathologic assessment suggests the presence of these pathogens. Our institution, however, performs these stains on all BAL specimens. Thus, we sought to determine whether this practice was cost effective, considering the turnaround time and diagnostic efficacy of these tests. METHODS: We retrospectively reviewed 488 BAL specimens performed at two military healthcare institutions over a 2-year period and performed a cost analysis with review of the impact on turnaround time. RESULTS: Of the 488 cases, we identified only 3 (~0.6%) with infections by acid-fast or fungal organisms, at an estimated total cost of $12,151.20 and an average delay of 3.0 to 3.5 hours for slide preparation. CONCLUSION: Our results suggest that in a largely young and healthy population such as ours, it may be more feasible to perform these stains on BAL specimens on a case-by-case basis rather than automatically on every specimen, to control costs and enhance productivity.","Lab Med, 46(1): 4-7","USA",2015,"Healthy",null,null,"Adults","Diagnostic Research,Cost and Resource Use","Retrospective Observational"]
[59,"Torres, R. A., et al. (1993). \"Randomized trial of dapsone and aerosolized pentamidine for the prophylaxis of Pneumocystis carinii pneumonia and toxoplasmic encephalitis.\" Am J Med 95(6): 573-583.",null,"Torres, R. A., et al.","Randomized trial of dapsone and aerosolized pentamidine for the prophylaxis of Pneumocystis carinii pneumonia and toxoplasmic encephalitis","PURPOSE: Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis are the most frequent pulmonary and central nervous system opportunistic infections associated with human immunodeficiency virus (HIV) infection. We designed a prospective study to compare the effects of aerosolized pentamidine and dapsone in the prophylaxis of these infections in HIV-infected persons with CD4+ lymphocyte counts less than 250/mm3. PATIENTS AND METHODS: Two hundred seventy-eight patients seropositive for HIV who had acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex were randomly assigned to receive intermittent dapsone (100 mg twice weekly) or aerosolized pentamidine (100 mg every 2 weeks). The proportion of patients remaining free of PCP or toxoplasmosis was analyzed with the log-rank test as a function of time, as were the effects of zidovudine or prophylaxis on survival. RESULTS: Dapsone and aerosolized pentamidine demonstrated similar efficacy in the primary and secondary prophylaxis of PCP, with 15 (18%) failures among patients receiving dapsone compared to 15 (14%) among those receiving aerosolized pentamidine (p = 0.4), after a mean length of follow-up of 42 and 44 weeks, respectively. Dapsone was more effective in the primary prophylaxis of toxoplasmic encephalitis, with six toxoplasmic encephalitis events occurring among those receiving aerosolized pentamidine, compared to none among those taking dapsone (p = 0.01). Primary prophylaxis for PCP was more effective than secondary prophylaxis with either therapy. Zidovudine therapy did not prevent PCP yet prolonged the PCP-free interval for those in whom either prophylactic therapy failed. Kaplan-Meier estimates did not show a difference in survival between the patients receiving either therapy, yet zidovudine use was associated with improved survival, independent of race and risk factor (Cox proportional hazards model, p = 0.001). The 1-month survival for patients developing PCP despite prophylaxis was better with those in whom dapsone failed than it was for those in whom aerosolized pentamidine failed (p = 0.08). CONCLUSION: Dapsone is as effective as aerosolized pentamidine in preventing PCP and has the advantage of a lower cost, easier administration, and possibly an additional preventive effect against toxoplasmosis. Zidovudine prolongs the PCP-free interval for patients receiving prophylaxis, regardless of which prophylactic agent is used.","Am J Med, 95(6): 573-583","USA",1993,"AIDS","Dapsone,Pentamidine",null,"Unknown","Mortality","Prospective Cohort"]
[60,"Wachter, R. M., et al. (1995). \"Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure.\" Jama 273(3): 230-235.",null,"Wachter, R. M., et al.","Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure","OBJECTIVE: To determine the costs and outcomes associated with intensive care unit (ICU) admission for patients with acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP), and severe respiratory failure. DESIGN: Survival and cost-effectiveness analysis. SETTING: A large municipal teaching hospital serving an indigent population. PATIENTS: Consecutive patients intubated and mechanically ventilated for AIDS, PCP, and respiratory failure from 1981 through 1991 (n = 113). The cohort was separated into three groups for analysis: patients admitted to the ICU in 1981 through 1985 (era I, n = 43), those admitted in 1986 through 1988 (era II, n = 33), and those admitted in 1989 through 1991 (era III, n = 37). MAIN OUTCOME MEASURES: Hospital charges and survival time; cost per year of life saved, using a zero-cost, zero-life assumption. RESULTS: Twenty-eight (25%) of the 113 patients mechanically ventilated for PCP and respiratory failure survived to hospital discharge: six (14%) of 43 in era I, 13 (39%) of 33 in era II, and nine (24%) of 37 in era III (P = .04). Post-ICU admission charges averaged $57,874 for the entire cohort, remaining relatively stable across the three eras. Cost of care for survivors was significantly more expensive than for those dying before discharge. The cost of ICU admission and subsequent hospitalization averaged $174,781 per year of life saved; $305,795 in era I, $94,528 in era II, and $215,233 in era III. Improved survival rates and shorter lengths of ICU stay led to the improved cost-effectiveness in era II, while the opposite trends resulted in worsening cost-effectiveness in recent years. The strongest predictors of hospital mortality in era III were low CD4 cell counts on hospital admission and the development of pneumothorax during mechanical ventilation. CONCLUSIONS: The cost-effectiveness of intensive care for patients with PCP and severe respiratory failure improved during the first 8 years of the AIDS epidemic but fell in recent years such that it is now below that of many accepted medical interventions.","Jama, 273(3): 230-235","USA",1995,"AIDS,Respiratory failure",null,null,"Unknown","Cost and Resource Use,Mortality","Retrospective Observational"]
[61,"Wasserman, S., et al. (2013). \"Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: protocol for a systematic review.\" Syst Rev 2: 112.",null,"Wasserman, S., et al.","Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: protocol for a systematic review","BACKGROUND: Reports from Africa have suggested that pneumocystis pneumonia (PCP) is a less important cause of morbidity than in the developed world. However, more recent studies have shown high seroprevalence rates of P. jirovecii in healthy individuals with HIV as well as high rates of clinical disease in African children. This suggests that PCP may be more common in Africa than was previously recognised. Understanding the contribution of PCP to disease in HIV-infected individuals in sub-Saharan Africa (SSA) has important implications for diagnosis, management and resource allocation. We therefore propose to conduct a systematic review and meta-analysis in order to investigate the burden of PCP in this population. METHODS AND DESIGN: We plan to search electronic databases and reference lists of relevant articles published from 1995 to May 2013 using broad terms for pneumocystis, HIV/AIDS and sub-Saharan Africa. Studies will be included if they provide clear diagnostic criteria for PCP and well-defined study populations or mortality data (denominator). A novel quality score assessment tool has been developed to ensure fidelity to inclusion criteria, minimise risk of selection bias between reviewers and to assess quality of outcome ascertainment. This will be applied to eligible full-text articles. We will extract data using a standardised form and perform descriptive and quantitative analysis to assess PCP prevalence, mortality and case fatality, as well as the quality of included studies. This review protocol has been published in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42013005530. DISCUSSION: Our planned review will contribute to the diagnosis and management of community-acquired pneumonia in HIV-infected individuals in SSA by systematically assessing the burden of PCP in this population. We also describe a novel quality assessment tool that may be applied to other prevalence reviews.","Syst Rev, 2(112","South Africa",2013,"HIV,AIDS",null,null,"Children","Mortality,Cross-Sectional","Systematic Review"]
[62,"Wehner, J. H., et al. (1994). \"Controlled utilization of induced sputum analysis in the diagnosis of Pneumocystis carinii pneumonia.\" Chest 105(6): 1770-1774.",null,"Wehner, J. H., et al.","Controlled utilization of induced sputum analysis in the diagnosis of Pneumocystis carinii pneumonia","We investigated the outcome and potential cost savings of a system designed to limit physician access to induced sputum analysis (ISA) for the diagnosis of Pneumocystis carinii pneumonia (PCP). Four respiratory medicine physicians screened all requests for ISA to determine the pretest likelihood of PCP. Twenty-two of 102 requests for ISA over a 1-year period were denied due to a low clinical suspicion for PCP. Seven individuals had a definitive alternative diagnosis confirmed and the remaining 15 were empirically treated for a presumptive diagnosis. All individuals were followed for at least 60 days or until death. None of the 22 individuals developed PCP during the follow-up period. We estimate that this approach saved $27,474, avoided exposure of health care workers to Mycobacterium tuberculosis, and was educational for the referring physicians.","Chest, 105(6): 1770-1774","USA",1994,"Not Specified",null,null,"Unknown","Diagnostic Research","Retrospective Observational"]
[63,"Weverling, G. J., et al. (1999). \"Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection. EuroSIDA Study Group.\" Lancet 353(9161): 1293-1298.",null,"Weverling, G. J., et al.","Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection. EuroSIDA Study Group","BACKGROUND: Highly active antiretroviral therapy (HAART) has improved rates of CD4-lymphocyte recovery and decreased the incidence of HIV-1-related morbidity and mortality. We assessed whether prophylaxis against Pneumocystis carinii pneumonia (PCP) can be safely discontinued after HAART is started. METHODS: We investigated 7333 HIV-1-infected patients already enrolled in EuroSIDA, a continuing prospective observational cohort study in 52 centres across Europe and Israel. We did a person-years analysis of the rate of discontinuation of PCP prophylaxis and of the incidence of PCP after the introduction of HAART into clinical practice from July, 1996. FINDINGS: The rate of discontinuation of primary and secondary PCP prophylaxis increased up to 21.9 discontinuations per 100 person-years of follow-up after March, 1998. 378 patients discontinued primary (319) or secondary (59) prophylaxis a median of 10 months after starting HAART. At discontinuation for primary and secondary prophylaxis, respectively, the median CD4-lymphocyte counts were 274 cells/microL and 270 cells/microL, the median plasma HIV-1 RNA load 500 copies/mL, and the median lowest recorded CD4-lymphocyte counts 123 cells/microL and 60 cells/microL. During 247 person-years of follow-up, no patient developed PCP (incidence density 0 [95% CI 0-1.5]). INTERPRETATION: The risk of PCP after stopping primary prophylaxis, especially in patients on HAART with a rise in CD4-lymphocyte count to more than 200 cells/microL, is sufficiently low to warrant discontinuation of primary PCP prophylaxis. Longer follow-up is needed to confirm a similarly low risk for stopping secondary PCP prophylaxis.","Lancet, 353(9161): 1293-1298","Netherlands",1999,"HIV","Antiretroviral therapy",null,"Unknown","Mortality","Prospective Cohort"]
[64,"Wynia, M. K., et al. (1998). \"Analysis of life-long strategies to prevent Pneumocystis carinii pneumonia in patients with variable HIV progression rates.\" Aids 12(11): 1317-1325.",null,"Wynia, M. K., et al.","Analysis of life-long strategies to prevent Pneumocystis carinii pneumonia in patients with variable HIV progression rates","OBJECTIVE: To compare strategies for life-long prophylaxis of Pneumocystis carinii pneumonia (PCP) in a group of AIDS patients with a wide range of disease progression rates. DESIGN: Markov decision models. METHODS: Prophylaxis strategies using high and low doses of trimethoprim-sulfamethoxazole (TS), dapsone, and/or aerosolized pentamidine in sequence, were compared. Efficacy and toxicity rates for prophylaxis regimens were taken from a meta-analysis of pertinent randomized controlled trials. Outcomes measured included lifetime episodes of PCP and drug toxicity per 100 patients treated, average life expectancy, and cost. RESULTS: For patients with an expected survival of 3 years after commencement of prophylaxis, the use of standard or low dose TS as the first choice agent was comparable, and both were superior to the other strategies for preventing PCP (between nine and 26 fewer episodes of PCP per 100 patients treated) though they were more toxic (11-44 more episodes of toxicity per 100 patients treated). Life expectancy was similar for all of the treatment strategies. With slower rates of disease progression (expected survival > 3.8 years), as seen with current antiretroviral regimens, the use of low dose TS as the first choice agent dominated the use of standard dose TS; when the expected survival time was 7 years, initial use of low dose TS led to 2.8 fewer episodes of PCP per 100 patients treated, 32 fewer episodes of toxicity per 100 patients treated, and US$1381 per patient lower cost, compared with prophylaxis with standard dose TS. CONCLUSION: For patients with AIDS and expected survival > 3.8 years, low dose TS is better than standard dose TS as the first choice agent for preventing PCP. As patients with AIDS live longer, the routine use of low dose TS will be more than adequate for patients at risk for PCP.","Aids, 12(11): 1317-1325","USA",1998,"AIDS","Dapsone,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model,Mortality","Retrospective Observational"]
[65,"Yeung, K. T., et al. (1996). \"The safety of i.v. pentamidine administered in an ambulatory setting.\" Chest 110(1): 136-140.",null,"Yeung, K. T., et al.","The safety of i.v. pentamidine administered in an ambulatory setting","I.v. pentamidine is well known to cause severe multiorgan adverse effects and is usually given to hospitalized patients under close monitoring. The primary purpose of this retrospective quality assurance study is to assess the safety of administering i.v. pentamidine in the medical daycare unit (MDCU) for outpatients. Thirty-five outpatients infected with the HIV made 306 visits to the MDCU from January 1991 to December 1993. They received i.v. pentamidine in a dosage of either 300 mg once a month for prophylaxis or 4 mg/kg/d 5 days a week for treatment of Pneumocystis carinii pneumonia (PCP). BP was monitored every 15 to 30 min over 3 to 4 h and clinical side effects were noted. CBC count, BUN, creatinine, amylase, and blood glucose values were taken twice a week. The records were reviewed retrospectively and analyzed for clinical and biochemical derangement. GI side effects occurred in 59 of 306 (19%) visits; 43 (73%) of the side effects were nausea. Routine normal saline solution boluses before and after pentamidine infusion prevented the drop in BP and actually significantly elevated BP after i.v. pentamidine. The most common biochemical derangement was elevated BUN level in eight patients and creatinine in nine patients, but they were mild and required no intervention. Significant neutropenia occurred in three, anemia in two, hyponatremia in two, hyperamylasemia in two, and hyperglycemia in two patients. No palpitation or irregular pulse was encountered. No death was associated with the administration of i.v. pentamidine. Three patients required hospital admission. Only one hospital admission was definitely related to adverse drug effects. In conclusion, the side effects of i.v. pentamidine are common but minor. We conclude that it is safe to administer i.v. pentamidine in carefully selected patients with appropriate monitoring in an ambulatory setting. This has a major health economic implication, because ambulatory i.v. pentamidine can result in significant cost savings and can also enhance quality of life. Further studies regarding the feasibility of home administration of i.v. pentamidine is warranted as even further cost savings and improvement in the quality of life of HIV-infected patients may be achieved.","Chest, 110(1): 136-140","Canada",1996,"HIV","Pentamidine",null,"Unknown","Mortality,Cross-Sectional","Retrospective Observational"]
[66,"Zarkin, G. A., et al. (1996). \"Estimating the cost effectiveness of atovaquone versus intravenous pentamidine in the treatment of mild-to-moderate Pneumocystis carinii pneumonia.\" Pharmacoeconomics 9(6): 525-534.",null,"Zarkin, G. A., et al.","Estimating the cost effectiveness of atovaquone versus intravenous pentamidine in the treatment of mild-to-moderate Pneumocystis carinii pneumonia","Pneumocystis carinii pneumonia (PCP) is the most common severe opportunistic infection, and one of the most costly, among people with AIDS. Over 50% of patients experience toxic effects of the major anti-PCP medications- cotrimoxazole (trimethoprim-sulfamethoxazole) and pentamidine. Recently, the US Food and Drug Administration approved a new oral drug therapy, atovaquone, as an alternative to pentamidine for the treatment of people with mild-to-moderate PCP who are intolerant of cotrimoxazole. We developed a decision tree model to estimate the costs and cost effectiveness of atovaquone therapy compared with intravenous pentamidine therapy for cotrimoxazole-intolerant patients with mild-to-moderate PCP. Clinical outcomes were based on data from a phase III trial comparing the 2 medications. Our economic outcomes were based on treatment algorithms derived from discharge data, published reports and the clinical judgement of the co-authors. We estimate the total expected cost of treating a patient for an episode of PCP with atovaquone to be $US3990 compared with $US6545 for pentamidine under our baseline scenario (1995 dollars). Our decision model also provides insight into the large cost-savings benefits of treating mild-to-moderate PCP on an outpatient basis.","Pharmacoeconomics, 9(6): 525-534","USA",1996,"AIDS","Atovaquone,Pentamidine",null,"Unknown","Economic Model","Retrospective Observational"]

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[1,"Aderaye,G.,et al. (2008). \"Evaluation of Toluidine Blue O staining for the diagnosis of Pneumocystis jiroveci in expectorated sputum sample and bronchoalveolar lavage from HIV-infected patients in a tertiary care referral center in Ethiopia.\" Infection 36(3): 237-243.",null,"Aderaye,G.,et al.","Evaluation of Toluidine Blue O staining for the diagnosis of Pneumocystis jiroveci in expectorated sputum sample and bronchoalveolar lavage from HIV-infected patients in a tertiary care referral center in Ethiopia","BACKGROUND: Pneumocystis pneumonia (PCP) is becoming increasingly recognized in sub-Saharan Africa. The currently recommended diagnostic methods using induced sputum (IS) and bronchoalveolar lavage (BAL) are neither technically feasible nor affordable for a wider clinical use in developing countries. Therefore,there is a need for a simple and affordable diagnostic test. METHODS: The yield of Toluidine Blue O (TBO) stain,immunofluorescence (IF),and polymerase chain reaction (PCR) for the diagnosis of Pneumocystis jiroveci were compared in 78 expectorated sputum and 118 BAL samples of 131 HIV-infected patients presenting with atypical chest X-ray and sputum smear-negative for acid-fast bacilli. RESULTS: A total of 56 (42.7%) patients tested positive for P. jiroveci by PCR,39 (29.4%) by IF,and 28 (21.4%) by TBO stain. The sensitivity of TBO as compared to IF and PCR was 71.4% and 34.5% in expectorated sputum and 68% and 41.5% in BAL samples,respectively,with a specificity approaching 100% in both. The sputum PCR showed high concordance rate with BAL PCR. The sensitivity and specificity of sputum PCR as compared to BALPCR was 78.9% and 89%,respectively. In both TBO and IF positive BAL samples,majority were from patients who could not produce sputum (p<0.001). The density of P. jiroveci clusters in BAL samples did not correlate with prior co-trimoxazole use,immunologic status of the patient or overall mortality. CONCLUSION: Compared to IF,TBO staining has an acceptable sensitivity and very high specificity both in expectorated sputum and BAL samples. Expectorated sputum is,therefore,the most practical specimen and TBO staining an inexpensive diagnostic method to be recommended for high-HIV,resource-constrained settings. Bronchoscopy for the diagnosis of PCP is often not required for patients who can produce sputum. For patients who cannot produce sputum,however,the cost and efficacy of TBO in IS sample needs to be investigated in resource-poor countries.","Infection,36(3): 237-243","Ethiopia",2008,"HIV",null,null,"Unknown","Diagnostic Research","Clinical Study","Ethiopia","Unknown","HIV",null,"Diagnostic Research","Clinical Study",null,"2005:2009","Bronchoalveolar lavage,Sputum Induction,X-ray"]
[2,"Anonymous (1995). \"Study questions increasing cost of intensive care of pneumocystis.\" AIDS Policy Law 10(2): 2.",null,"Anonymous","Study questions increasing cost of intensive care of pneumocystis","AIDS: According to a new study,intensive care for AIDS patients with severe pneumonia is becoming so expensive that policy makers may decide to ration or refuse treatments. Researchers at the University of California-San Francisco (UCSF) found that it costs an average of $215,000 to extend by one year the life of an AIDS patient who is treated for pneumocystis carinii pneumonia (PCP) in a hospital's intensive care unit. This is twice as much as comparable care cost in 1988. AIDS patients are surviving longer,with some suffering their second or third PCP infection,increasing the cost. Researchers were careful to note that rationing health care means certain death for some AIDS patients with PCP.","AIDS Policy Law,10(2): 2","Unknown",1995,"AIDS",null,null,"Unknown","Cost and Resource Use","Narrative Review","Unknown","Unknown","AIDS",null,"Cost and Resource Use","Narrative Review",null,"1995:1999"]
[3,"Asai,N.,et al. (2012). \"A successful diagnostic case of Pneumocystis pneumonia by the loop-mediated isothermal amplification method in a patient with dermatomyositis.\" J Infect Chemother 18(6): 965-969.",null,"Asai,N.,et al.","A successful diagnostic case of Pneumocystis pneumonia by the loop-mediated isothermal amplification method in a patient with dermatomyositis","Pneumocystis pneumonia (PCP) can occur in patients with many causes of the immunocompromised state other than human immunodeficiency virus (HIV). It is quite difficult to diagnose PCP without HIV because there is no method for detecting Pneumocystis jirovecii. Thus,non-HIV PCP continues to have high mortality. Recently,loop-mediated isothermal amplification (LAMP) is becoming an established nucleic acid amplification method offering rapid,accurate,and cost-effective diagnosis of infectious diseases. We report a non-HIV PCP case successfully diagnosed by the LAMP method. It was previously reported that PCR in BALF specimens had been the most sensitive method in the diagnosis of PCP without HIV. The LAMP method would be more sensitive than conventional PCR and an effective tool in the early diagnosis of PCP.","J Infect Chemother,18(6): 965-969","Japan",2012,"Dermatomyositis",null,null,"Unknown","Diagnostic Research","Case Study","Japan","Unknown","Dermatomyositis",null,"Diagnostic Research","Case Study",null,"2010:2014","Nucleic acid amplification"]
[4,"Bastian,L.,et al. (1993). \"Differences between men and women with HIV-related Pneumocystis carinii pneumonia: experience from 3,070 cases in New York City in 1987.\" J Acquir Immune Defic Syndr 6(6): 617-623.",null,"Bastian,L.,et al.","Differences between men and women with HIV-related Pneumocystis carinii pneumonia: experience from 3,070 cases in New York City in 1987","Although women make up the fastest growing group of persons with AIDS,studies of human immunodeficiency virus (HIV)-infected persons reported to date have included predominantly or exclusively men. We evaluated sex differences in sociodemographic characteristics,hospital characteristics,in-hospital resource use,and short-term mortality rates for 2,526 men and 544 women admitted for their first-episode of HIV-related Pneumocystis carinii pneumonia (PCP) in New York City in 1987. Compared with men,women were significantly less likely to be white (81% vs. 54%,p < or = 0.001) or have private health insurance (80% vs. 58%,p < or = 0.001),and more likely to be admitted through an emergency room (79% vs. 71%,p < or = 0.001) and receive care at hospitals that had less experience treating PCP (p < or = 0.001). Women were more likely than men to die in the hospital [33% vs. 24%; crude odds ratio = 1.56,confidence interval (CI) = 1.28-1.91,p < or = 0.001]. In a logistic regression model,the risk of death in the hospital was associated with age 60-65 years [adjusted odds ratio (AOR) = 4.19,CI = 2.13-8.21],not having private health insurance (AOR = 1.37,CI = 1.08-1.75),admission through the emergency room (AOR = 1.54,CI = 1.21-1.96),and receiving care at hospitals with less experience treating PCP (AOR = 1.63,CI = 1.15-2.30),but women were not significantly more likely to die in the hospital than men (AOR = 1.18,CI = 0.93-1.50). Poorer access to medical care as well as higher use of hospitals with less experience treating AIDS may account for the difference in mortality rates observed in women with HIV-related PCP.","J Acquir Immune Defic Syndr,6(6): 617-623","USA",1993,"HIV",null,null,"Unknown","Cost and Resource Use,Mortality,Epidemiology","Retrospective Observational","USA","Unknown","HIV",null,"Cost and Resource Use,Mortality,Epidemiology","Retrospective Observational",null,"1990:1994"]
[5,"Benfield,T. L.,et al. (1995). \"Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia.\" Respir Med 89(4): 285-290.",null,"Benfield,T. L.,et al.","Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia","Pneumocystis carinii pneumonia (PCP) may cause severe respiratory distress. This is believed to be partly caused by the accumulation of neutrophils in the lung. Interleukin-8 (IL-8) and leukotriene B4 (LTB4) are potent neutrophil chemo-attractants and activators. Eicosanoids [i.e. prostaglandins (PG) and leukotrienes (LT)] are pro-inflammatory mediators released from arachidonic acid by action of phospholipase A2 (PLA2) and have been implicated in the host response to micro-organisms. Bronchoalveolar lavage (BAL) was performed on patients with PCP as part of a randomized study of adjuvant corticosteroids vs. placebo,in addition to standard antimicrobial therapy. Re-bronchoscopy was offered at day 10. BAL fluid was available for 26 patients who had follow-up bronchoscopy performed. At diagnosis,IL-8 levels were elevated in patients with PCP,compared to healthy controls,and correlated with relative BAL neutrophilia and P(A-a)O2. LTB4 was also elevated in PCP,but failed to correlate with either BAL neutrophilia or P(A-a)O2. PLA2 activity in patients correlated with IL-8 levels and BAL neutrophilia,but not with P(A-a)O2. A trend towards a decrease in IL-8 levels in BAL fluid was detected in the corticosteroid-treated patients from days 0-10,whereas no change was detected in the placebo group. No change in levels of LTB4,LTC4,PGE2,PGF2a and PLA2 were detected cover time in either treatment group. This study establishes a correlation between IL-8,BAL neutrophilia and P(A-a)O2,and suggests a role of IL-8 as a mediator in the pathogenesis of PCP,whereas the role of eicosanoids seems less clear.","Respir Med,89(4): 285-290","Denmark",1995,"Not Specified",null,null,"Unknown","Mortality","RCT","Denmark","Unknown","Not Specified",null,"Mortality","RCT",null,"1995:1999"]
[6,"Bennett,C. L.,et al. (1990). \"The relation between resource use and in-hospital mortality for patients with acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia.\" Arch Intern Med 150(7): 1447-1452.",null,"Bennett,C. L.,et al.","The relation between resource use and in-hospital mortality for patients with acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia","A central issue in health policy with regard to the acquired immunodeficiency syndrome (AIDS) is whether quality of care and patient outcomes are affected by resource constraints. In an earlier study of 15 California hospitals between October 1986 and October 1987,we observed a markedly lower in-hospital mortality rate for Pneumocystis carinii pneumonia in the group of patients treated in hospitals that had a high level of experience with AIDS relative to the group treated in hospitals with low experience. We present the patterns of resource use at hospitals with high and low AIDS familiarity. Average charges and resource use did not differ between the two groups of hospitalized patients; however,there were marked variations in how the resources were used. Among survivors,patients who received care at hospitals with high AIDS familiarity stayed in the hospital longer,underwent a bronchoscopy more often,stayed in an intensive care unit longer,and accrued higher average total charges than patients at hospitals with low AIDS familiarity. Conversely,among nonsurvivors,a greater intensity of care was received at the hospitals with low AIDS familiarity. These results suggest that,in these 15 hospitals,the markedly higher rate of in-hospital death at hospitals with low AIDS familiarity was not related to the quantity of resources that were used; rather it was related to differences in how the resources were used. Our results show that additional resources significantly improved the chances of in-hospital survival for patients at hospitals with high AIDS familiarity,but did not affect the chances of survival in hospitals with low AIDS familiarity. Our findings suggest that physicians in those hospitals in which the care of patients with AIDS is relatively infrequent might improve the chances of in-hospital survival of patients with AIDS by more timely and efficient use of resources.","Arch Intern Med,150(7): 1447-1452","USA",1990,"AIDS",null,null,"Unknown","Cost and Resource Use,Mortality","Observational","USA","Unknown","AIDS",null,"Cost and Resource Use,Mortality","Observational",null,"1990:1994"]
[7,"Bennett,C. L.,et al. (1995). \"Cost-effectiveness models of clinical trials of new pharmaceuticals for AIDS-related Pneumocystis carinii pneumonia: are they helpful to policy makers?\" Clin Perform Qual Health Care 3(3): 156-164.",null,"Bennett,C. L.,et al.","Cost-effectiveness models of clinical trials of new pharmaceuticals for AIDS-related Pneumocystis carinii pneumonia: are they helpful to policy makers?","BACKGROUND: Pneumocystis carinii pneumonia (PCP) has been the most common and most costly complication of acquired immunodeficiency syndrome (AIDS). Because of concern over the high costs of care for persons with AIDS,policy makers have instituted a number of new measures to encourage cost-effectiveness. Although the clinical efficacy of new pharmaceutical agents is evaluated extensively before approval,comparative trials of a new agent with its major competitor are sometimes not carried out,and estimates of cost-effectiveness are therefore difficult to obtain. METHODS: We describe methodologic issues associated with the development of economic models of new pharmaceutical agents and illustrate these issues with an analysis of second-line therapeutic options for PCP. RESULTS: A new drug,trimetrexate,and the standard second-line therapy,pentamidine,are both inferior to the standard first-line therapy,trimethoprim/sulfamethoxazole,as initial therapy for moderate to severe PCP. However,as many as half of the patients with PCP are either intolerant or refractory to trimethoprim/sulfamethoxazole therapy for PCP. Economic models suggest that,if the two drugs have identical survival rates,then trimetrexate,despite a higher acquisition cost,is both less expensive and more effective in achieving toxicity-free survival than pentamidine in patients who require second-line therapy for PCP. Sensitivity analyses indicate that trimetrexate is less expensive than pentamidine over a wide range of estimates of costs and effectiveness. CONCLUSIONS: To make well-informed therapeutic decisions,policy makers and physicians require head-to-head studies of a new pharmaceutical agent with its major competitor. However,economic models can be used to derive estimates of cost-effectiveness of new pharmaceutical agents when such data are lacking. The interpretation of these models raises general issues related to the perspective of the investigators,study design,estimation of costs of care,rates of response,toxicity,and survival,and generalizability of the results to other settings as well as methodologic issues that are unique to human immunodeficiency virus (HIV) disease. If a comparative trial found better survival rates,then cost-effectiveness models would be of limited usefulness; almost all physicians would use the drug with the higher survival rate.","Clin Perform Qual Health Care,3(3): 156-164","USA",1995,"AIDS","Trimetrexate,Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model","Observational","USA","Unknown","AIDS","Trimetrexate,Pentamidine,Trimethoprim-sulfamethoxazole","Economic Model","Observational",null,"1995:1999"]
[8,"Bennett,C. L.,et al. (1996). \"U.S. hospital care for HIV-infected persons and the role of public,private,and Veterans Administration hospitals.\" J Acquir Immune Defic Syndr Hum Retrovirol 13(5): 416-421.",null,"Bennett,C. L.,et al.","U.S. hospital care for HIV-infected persons and the role of public,private,and Veterans Administration hospitals","Hospitals are a major provider of medical care for human immunodeficiency virus (HIV)-infected persons. Although utilization and patterns of care profiles in public and private hospitals have been evaluated for acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP),one of the most costly and common severe complications of AIDS,information from Veterans Administration (VA) hospitals has not been reported previously. This article reports on inpatient care for PCP patients by obtaining data from VA,private,and public hospitals. Cost and resource utilization data were obtained from reviews of medical records,claims,and provider bills from 26 non-VA hospitals and 18 VA hospitals in 10 cities in the United States. Data on severity of illness,patterns of care,and outcomes for PCP were obtained from medical record reviews from 2,174 PCP cases treated in 82 non-VA and 14 VA hospitals in five U.S. cities. Estimates were made of the average costs and the rates of use of diagnostic tests,anti-PCP medications,and intensive care units for samples of public hospital,private hospital,and VA patients with PCP. With mean charges for a single PCP episode of $14,500 to $16,060,PCP remains one of thea most costly complications of AIDS. Although the severity of PCP illness at admission was greatest at public hospitals,the intensity of care was lowest: for frequency of cytologic diagnosis (48% at public,62% at VA,and 66% at private hospitals),bronchoscopy (45% at public,60% at VA,and 66% at private hospitals),and intensive care unit use (11% at public,22% at VA,and 19% at private hospitals). In-hospital mortality rates for PCP also differed in the three types of hospitals (20% at public,24% at VA,and 18% at private hospitals). Patterns of PCP care differ among VA,public,and private hospitals. Future studies on the HIV epidemic should include data collected from uniform data sources from VA hospitals,in addition to public and private hospitals,to provide insight on the processes of care and outcomes for HIV-infected persons.","J Acquir Immune Defic Syndr Hum Retrovirol,13(5): 416-421","USA",1996,"HIV,AIDS",null,null,"Veterans","Cost and Resource Use","Retrospective Observational","USA","Veterans","HIV,AIDS",null,"Cost and Resource Use","Retrospective Observational",null,"1995:1999"]
[9,"Bennett,R. L.,et al. (1993). \"Improved outcomes in intensive care units for AIDS-related Pneumocystis carinii pneumonia: 1987-1991.\" J Acquir Immune Defic Syndr 6(12): 1319-1321.",null,"Bennett,R. L.,et al.","Improved outcomes in intensive care units for AIDS-related Pneumocystis carinii pneumonia: 1987-1991","Respiratory failure due to Pneumocystis carinii pneumonia (PCP) is the most common complication requiring an intensive care unit (ICU) for persons with AIDS. In this study,we evaluated patterns of ICU use for ICU patients with first-episode PCP in 15 Veterans Administration Medical Centers from 1987 to 1991. Twelve percent of all patients with PCP received care in the ICU. The survival rates improved steadily during these years. Although there was little variation in the relative frequency of ICU use,the effectiveness of ICU use appeared to improve over time. In the more recent years,relatively more survivors and relatively fewer nonsurvivors received care in an ICU. Changes in medical practice such as adjunctive use of steroids for severe cases of PCP and more effective use of scarce resources may account for the improved survival rates for patients with PCP who are treated in an ICU.","J Acquir Immune Defic Syndr,6(12): 1319-1321","USA",1993,"AIDS",null,null,"Veterans","Cost and Resource Use,Mortality","Retrospective Observational","USA","Veterans","AIDS",null,"Cost and Resource Use,Mortality","Retrospective Observational",null,"1990:1994"]
[10,"Botterel,F.,et al. (2012). \"Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients.\" J Clin Microbiol 50(2): 227-231.",null,"Botterel,F.,et al.","Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients","Quantitative PCR (qPCR) is more sensitive than microscopy for detecting Pneumocystis jirovecii in bronchoalveolar lavage (BAL) fluid. We therefore developed a qPCR assay and compared the results with those of a routine immunofluorescence assay (IFA) and clinical data. The assay included automated DNA extraction,amplification of the mitochondrial large-subunit rRNA gene and an internal control,and quantification of copy numbers with the help of a plasmid clone. We studied 353 consecutive BAL fluids obtained for investigation of unexplained fever and/or pneumonia in 287 immunocompromised patients. No qPCR inhibition was observed. Seventeen (5%) samples were both IFA and qPCR positive,63 (18%) were IFA negative and qPCR positive,and 273 (77%) were both IFA and qPCR negative. The copy number was significantly higher for IFA-positive/qPCR-positive samples than for IFA-negative/qPCR-positive samples (4.2 +/- 1.2 versus 1.1 +/- 1.1 log(10) copies/mul; P < 10(-4)). With IFA as the standard,the qPCR assay sensitivity was 100% for >/=2.6 log(10) copies/mul and the specificity was 100% for >/=4 log(10) copies/mul. Since qPCR results were not available at the time of decision-making,these findings did not trigger cotrimoxazole therapy. Patients with systemic inflammatory diseases and IFA-negative/qPCR-positive BAL fluid had a worse 1-year survival rate than those with IFA-negative/qPCR-negative results (P < 10(-3)),in contrast with solid-organ transplant recipients (P = 0.88) and patients with hematological malignancy (P = 0.26). Quantifying P. jirovecii DNA in BAL fluids independently of IFA positivity should be incorporated into the investigation of pneumonia in immunocompromised patients. The relevant threshold remains to be determined and may vary according to the underlying disease.","J Clin Microbiol,50(2): 227-231","France",2012,"Immunocompromised",null,null,"Unknown","Pathology","Clinical Study","France","Unknown","Immunocompromised",null,"Pathology","Clinical Study",null,"2010:2014"]
[11,"Castellano,A. R. and M. D. Nettleman (1991). \"Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia.\" Jama 266(6): 820-824.",null,"Castellano,A. R. and M. D. Nettleman","Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia","OBJECTIVE: To determine the relative cost and benefit of aerosolized pentamidine and the combination product of sulfamethoxazole and trimethoprim sulfate as secondary prophylaxis for Pneumocystis carinii pneumonia. DESIGN: A Markov-based cost-benefit analysis was performed. Drug efficacies,toxicities,and mortality rates were drawn from the current literature. SETTING: Hypothetical. PATIENT POPULATION: Patients infected with the human immunodeficiency virus who had had at least one episode of P carinii pneumonia. INTERVENTIONS: Regimen 1 required the use of aerosolized pentamidine as the sole first-line prophylactic agent in all patients. Regimen 2 required the use of sulfamethoxazole-trimethoprim in all patients who had no history of a toxic reaction to the drug; only patients with a history of toxic effects and those who developed toxic effects while receiving the drug would receive aerosolized pentamidine. Regimen 3 required that no secondary prophylaxis be given. MAIN OUTCOME MEASURES: Net cost,median patient survival,and 5-year survival for each regimen and for regimens 1 and 2 compared with regimen 3. MAIN RESULTS: Regimen 2 was dominant,with a net cost of $6332 per patient and a median survival of 2.050 years. Compared with no prophylaxis,regimen 2 resulted in a savings of $16,503 per patient and a 0.696-year increase in median survival. Compared with regimen 1,regimen 2 resulted in a savings of $2904 and a 0.067-year increase in median survival. CONCLUSIONS: Secondary prophylaxis for P carinii saves money and extends survival. Current data suggest that sulfamethoxazole-trimethoprim should be given whenever it can be tolerated. Use of aerosolized pentamidine as a first-line agent would result in a modest increase in cost and a decrease in life expectancy.","Jama,266(6): 820-824","USA",1991,"HIV","Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model,Mortality","Observational","USA","Unknown","HIV","Pentamidine,Trimethoprim-sulfamethoxazole","Economic Model,Mortality","Observational",null,"1990:1994"]
[12,"Chaisson,R. E.,et al. (1992). \"Pneumocystis prophylaxis and survival in patients with advanced human immunodeficiency virus infection treated with zidovudine. The Zidovudine Epidemiology Group.\" Arch Intern Med 152(10): 2009-2013.",null,"Chaisson,R. E.,et al.","Pneumocystis prophylaxis and survival in patients with advanced human immunodeficiency virus infection treated with zidovudine. The Zidovudine Epidemiology Group","BACKGROUND: Pneumocystis carinii pneumonia (PCP) is a major cause of morbidity and mortality in persons with advanced human immunodeficiency virus (HIV) infection. We assessed the impact of prophylaxis for PCP on survival in patients with advanced HIV disease who were treated with zidovudine. METHODS: A cohort of 1048 patients with prior PCP (N = 437),another acquired immunodeficiency syndrome-defining diagnosis (N = 168) or acquired immunodeficiency syndrome-related complex (N = 443) and with less than 0.250 x 10(9)/L CD4 cells initiated zidovudine treatment between April 1987 and April 1988. They were then followed up for 24 months. Morbidity and mortality outcomes were assessed every 2 months. A time-dependent,Cox proportional hazards model was used to identify factors associated with new episodes of PCP and with survival. RESULTS: Three hundred thirty-six patients (32%) developed PCP after beginning treatment with zidovudine,with a 24-month actuarial rate of 41%. Patients with prior PCP were more likely to develop PCP during follow up (40%) than those without a history of PCP at entry (27% with PCP at follow-up). Other factors associated with developing PCP were baseline acquired immunodeficiency syndrome vs acquired immunodeficiency syndrome-related complex,and dose interruptions of zidovudine. Thirty-six (17%) of 210 patients who received trimethoprim-sulfamethoxazole prophylaxis developed PCP vs 299 (36%) of 838 who never received trimethoprim-sulfamethoxazole (odds ratio,0.48). One hundred seven (22%) of 483 patients who ever received aerosol pentamidine prophylaxis developed PCP vs 228 (40%) of 565 who did not receive aerosol pentamidine (odds ratio,0.55). In a time-dependent Cox proportional hazards analysis,trimethoprim-sulfamethoxazole (relative hazard,0.21; 95% confidence interval [CI],0.11 to 0.4) and aerosol pentamidine prophylaxis (relative hazard,0.25; 95% CI,0.16 to 0.39) were associated with decreased risk of PCP. Pneumocystis carinii pneumonia during follow-up was strongly associated with death when controlling for other factors (odds ratio,1.8). For all patients,aerosol pentamidine prophylaxis was associated with a reduced risk of death during follow-up (relative hazard,0.59; 95% CI,0.44 to 0.78),while trimethoprim-sulfamethoxazole showed a weaker association (relative hazard,0.74; 95% CI,0.54 to 1.1). However,there was a significantly reduced risk of death overall for patients who consistently used trimethoprim-sulfamethoxazole (relative hazard,0.55; 95% CI,0.35 to 0.88) or aerosol pentamidine (relative hazard,0.57; 95% CI,0.42 to 0.77) and this was most pronounced in patients with a baseline history of PCP. DISCUSSION AND CONCLUSIONS: Pneumocystis carinii pneumonia was common in advanced HIV infection treated with zidovudine. Prophylaxis with trimethoprim-sulfamethoxazole and aerosol pentamidine both were associated with a decreased likelihood of PCP,and consistent use of each was associated with improved survival. Prophylaxis for PCP is associated with prolonged survival for patients with advanced HIV disease.","Arch Intern Med,152(10): 2009-2013","USA",1992,"HIV","Zidovudine,Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality,Cross-Sectional","Retrospective Observational","USA","Unknown","HIV","Zidovudine,Pentamidine,Trimethoprim-sulfamethoxazole","Mortality,Cross-Sectional","Retrospective Observational",null,"1990:1994"]
[13,"Chouaid,C.,et al. (1993). \"Cost effectiveness of noninvasive oxygen saturation measurement during exercise for the diagnosis of Pneumocystis carinii pneumonia.\" Am Rev Respir Dis 147(6 Pt 1): 1360-1363.",null,"Chouaid,C.,et al.","Cost effectiveness of noninvasive oxygen saturation measurement during exercise for the diagnosis of Pneumocystis carinii pneumonia","We assessed (1) the sensitivity and specificity of exercise oxygen saturation measurement (EOS) for the diagnosis of Pneumocystis carinii pneumonia (PCP); and (2) the cost of introducing this indirect diagnostic test compared with that of standard diagnostic strategies for PCP. In a prospective study,85 HIV-infected patients with suspected PCP underwent EOS,followed by induced sputum (IS) and bronchoalveolar lavage (BAL) if IS was negative for P. carinii. The prevalence of PCP was 0.22,the sensitivity of IS was 0.6,and its specificity was perfect. The cost ratios of IS to BAL and EOS to BAL were 0.1 and 0.2,respectively. A desaturation of three points was the best cutoff point,giving perfect sensitivity and a specificity of 0.77. The cost analysis showed that the introduction of EOS into diagnostic strategies for PCP is highly justified when the local prevalence is low. Exercise oxygen saturation measurement is simple and safe,and the results are available rapidly; its sensitivity is perfect and its specificity good. Its economic utility depends on its cost and the local prevalence of PCP in the test population.","Am Rev Respir Dis,147(6 Pt 1): 1360-1363","France",1993,"HIV",null,null,"Unknown","Cost and Resource Use,Diagnostic Research","Clinical Study","France","Unknown","HIV",null,"Cost and Resource Use,Diagnostic Research","Clinical Study",null,"1990:1994","Bronchoalveolar lavage,Sputum Induction"]
[14,"Chouaid,C.,et al. (1995). \"Cost-analysis of four diagnostic strategies for Pneumocystis carinii pneumonia in HIV-infected subjects.\" Eur Respir J 8(9): 1554-1558.",null,"Chouaid,C.,et al.","Cost-analysis of four diagnostic strategies for Pneumocystis carinii pneumonia in HIV-infected subjects","The aim of this study was to analyse the cost-effectiveness ratio of four diagnostic strategies for Pneumocystis carinii pneumonia (PCP) in patients infected with human immunodeficiency virus (HIV). Two hundred and ten HIV-infected patients with suspected PCP underwent induced-sputum (IS) followed,if negative,by bronchoalveolar lavage (BAL); 85 of these patients were able to undergo an exercise test (ET),prior to induced sputum and BAL. The following strategies were analysed: BAL strategy (BAL whenever PCP is suspected); IS strategy (induced sputum followed by BAL if negative); exercise test (ET) strategy,(ET followed by BAL if the results are abnormal); and the ES (exercise sputum) strategy (i.e. BAL only after abnormal ET and negative IS). The cost of each strategy was calculated by taking into account only direct costs; the conditions in which two given strategies would be cost-equivalent were also evaluated. The prevalence of PCP in this population was 31%; IS had 100% specificity and 71% sensitivity,whilst ET had 100% sensitivity and 77% specificity. The costs of BAL,IS,ET and ES strategies were 210,000,191,940,140,700 and 112,700 FF,respectively. The ES strategy is,thus,most suitable for our unit. The most economic strategy depends not only on the cost and characteristics of the procedures,but also on the prevalence of PCP in the test population. In conclusion,we developed a model for use by diagnostic centres in choosing the most suitable strategy,on the basis of the local prevalence of PCP.","Eur Respir J,8(9): 1554-1558","France",1995,"HIV","Exercise test",null,"Unknown","Cost and Resource Use,Epidemiology,Diagnostic Research","Clinical Study","France","Unknown","HIV","Exercise test","Cost and Resource Use,Epidemiology,Diagnostic Research","Clinical Study",null,"1995:1999","Bronchoalveolar lavage,Sputum Induction,Exercise Sputum"]
[15,"Chouaid,C.,et al. (1995). \"Use of the polymerase chain reaction technique on induced-sputum samples for the diagnosis of Pneumocystis carinii pneumonia in HIV-infected patients. A clinical and cost-analysis study.\" Am J Clin Pathol 104(1): 72-75.",null,"Chouaid,C.,et al.","Use of the polymerase chain reaction technique on induced-sputum samples for the diagnosis of Pneumocystis carinii pneumonia in HIV-infected patients. A clinical and cost-analysis study","The purpose of this study was to assess the sensitivity and specificity of the polymerase chain reaction (PCR) on induced sputum (IS) for the diagnosis of Pneumocystis carinii pneumonia (PCP) in HIV-infected patients,as well as its diagnostic value and cost as a routine clinical tool. Forty-nine patients with suspected PCP who had IS were studied and if negative,followed by bronchoalveolar lavage (BAL). Pneumocystis carinii was detected in these samples using standard staining techniques. Polymerase chain reaction was used with IS samples in a blinded fashion. The patients with negative BAL samples were closely monitored for 1 month. In the absence of any clinical or radiologic features of PCP during this period,they were considered as being free of PCP. The cost analysis considered only the direct costs of the various tests in three diagnostic strategies: routine BAL (BAL); IS with standard staining,if negative,followed by BAL (IS); and IS with standard staining followed,if negative,by PCR on IS samples (PCR-IS). Using standard staining P carinii was found in 13 cases (6 IS and 7 BAL). None of the 36 patients with negative BAL developed further signs of PCP. Thus,the prevalence of PCP was 26.5% and the sensitivity and specificity of BAL were 100%. Standard staining of IS had a specificity of 100% and a sensitivity of 46.5%. The sensitivity and specificity of PCR-IS were each 100%. The costs of strategies BAL,IS,and PCR-IS were $14,010,$18,300,and $18,040,respectively. The costs of the BAL strategy depended only on the cost of the relevant tests,whereas the costs of strategies IS and PCR-IS depended on the costs of the tests,the sensitivity of IS with standard staining,and the prevalence of PCP in the test population. The routine clinical use of PCR-IS is currently limited by the time required to obtain the results.","Am J Clin Pathol,104(1): 72-75","France",1995,"HIV",null,null,"Unknown","Cost and Resource Use,Diagnostic Research","Clinical Study","France","Unknown","HIV",null,"Cost and Resource Use,Diagnostic Research","Clinical Study",null,"1995:1999","Bronchoalveolar lavage,Sputum Induction"]
[16,"Chung,J. B.,et al. (2000). \"Cost-effectiveness of prophylaxis against Pneumocystis carinii pneumonia in patients with Wegner's granulomatosis undergoing immunosuppressive therapy.\" Arthritis Rheum 43(8): 1841-1848.",null,"Chung,J. B.,et al.","Cost-effectiveness of prophylaxis against Pneumocystis carinii pneumonia in patients with Wegner's granulomatosis undergoing immunosuppressive therapy","OBJECTIVE: To assess the incremental cost-effectiveness of 3 Pneumocystis carinii pneumonia (PCP) prophylaxis strategies in patients with Wegener's granulomatosis (WG) receiving immunosuppressive therapies: 1) no prophylaxis; 2) trimethoprim/sulfamethoxazole (TMP/SMX) 160 mg/800 mg 3 times a week,which is discontinued if patients experience an adverse drug reaction (ADR); and 3) TMP/SMX 160 mg/800 mg 3 times a week,which is replaced by monthly aerosolized pentamidine (300 mg) if patients experience an ADR. METHODS: A Markov state-transition model was developed to follow a hypothetical cohort of WG patients over their lifetimes starting from the time of initial exposure to the immunosuppressive therapy. The effect of PCP prophylaxis on life expectancy,quality-adjusted life expectancy,average discounted lifetime cost (ADLC),and incremental cost-effectiveness was estimated based on data obtained from a literature review. Direct medical costs were examined from a societal perspective,and costs and benefits were discounted at 3% annually. RESULTS: No prophylaxis resulted in a life expectancy of 13.36 quality-adjusted life years (QALY) at an ADLC of $4,538. In comparison,prophylaxis with TMP/ SMX alone increased the QALY to 13.54 and was cost saving,with an ADLC of $3,304. The addition of pentamidine in patients who had an ADR to TMP/SMX resulted in 13.61 QALY,with an ADLC of $7,428. Compared with TMP/SMX alone,TMP/SMX followed by pentamidine increased the QALY by 0.07 at an incremental cost of $58,037 per QALY. Both TMP/SMX alone and TMP/SMX followed by pentamidine prophylaxis strategies dominated the no prophylaxis strategy until the incidence of PCP fell below 0.2% and 2.25%,respectively. Institution of pentamidine therapy for patients with a TMP/SMX ADR increased quality-adjusted life expectancy compared with that with TMP/ SMX alone until the incidence of PCP rose above 7.5%. CONCLUSION: Prophylaxis using TMP/SMX alone increased life expectancy and reduced cost for patients with WG receiving immunosuppressive therapy. Replacing TMP/SMX with monthly aerosolized pentamidine in cases of ADR further increased life expectancy,although at an increased cost.","Arthritis Rheum,43(8): 1841-1848","USA",2000,"Wegner's granulomatosis","Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model","Observational","USA","Unknown","Wegner's granulomatosis","Trimethoprim-sulfamethoxazole","Economic Model","Observational",null,"2000:2004"]
[17,"Crabtree-Ramirez,B.,et al. (2016). \"Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America.\" PLoS One 11(6): e0153921.",null,"Crabtree-Ramirez,B.,et al.","Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America","BACKGROUND: Since 2009,earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in \"real life\" settings in Latin America has not been evaluated. METHODS: Patients in the Caribbean,Central and South America network for HIV Epidemiology (CCASAnet) >/=18 years of age at enrolment,from 2001-2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models. RESULTS: A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina,686 from Brazil,283 from Chile,119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%),followed by Pneumocystis pneumonia (24%),Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8-12.1) weeks before 2009 to 4.3 (IQR 2.0-7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001),having a non-tuberculosis OI (p<0.001),study site (p<0.001),and more recent years of OI diagnosis (p<0.001). DISCUSSION: The time from diagnosis of an OI to HAART initiation has decreased in Latin America coinciding with the publication of evidence of its benefit. We found important heterogeneity between sites which may reflect differences in clinical practices,local guidelines,and access to HAART. The impact of the timing of HAART initiation after OI on patient survival in this \"real life\" context needs further evaluation.","PLoS One,11(6): e0153921","Argentina,Brazil,Chile,Honduras,Mexico",2016,"HIV,AIDS",null,null,"Adults","Mortality,Cross-Sectional","Retrospective Observational","Argentina,Brazil,Chile,Honduras,Mexico","Adults","HIV,AIDS",null,"Mortality,Cross-Sectional","Retrospective Observational",null,"2015:2018"]
[18,"Creemers-Schild,D.,et al. (2016). \"Treatment of Pneumocystis pneumonia with intermediate-dose and step-down to low-dose trimethoprim-sulfamethoxazole: lessons from an observational cohort study.\" Infection 44(3): 291-299.",null,"Creemers-Schild,D.,et al.","Treatment of Pneumocystis pneumonia with intermediate-dose and step-down to low-dose trimethoprim-sulfamethoxazole: lessons from an observational cohort study","BACKGROUND: The recommended treatment of Pneumocystis jirovecii pneumonia (PCP) is high-dose trimethoprim-sulfamethoxazole (TMP-SMX) in an equivalent of TMP 15-20 mg/kg/day and SMX 75-100 mg/kg/day for 2 or 3 weeks. High rates of adverse events are reported with this dose,which raises the question if lower doses are possible. METHODS: All adult patients diagnosed with PCP in various immune dysfunctions and treated with TMP-SMX between January 1,2003 and July 1,2013 in a tertiary university hospital were included. Per institutional protocol,patients initiated treatment on intermediate-dose TMP-SMX (TMP 10-15 mg/kg/day) and could be stepped down to low-dose TMP-SMX (TMP 4-6 mg/kg/day) during treatment. Clinical variables at presentation,relapse rate and mortality rates were compared between intermediate- and step-down treatment groups by uni- and multivariate analyses. RESULTS: A total of 104 patients were included. Twenty-four patients (23 %) were switched to low-dose TMP-SMX after a median of 4.5 days (IQR 2.8-7.0 days). One relapse (4 %) occurred in the step-down group versus none in the intermediate-dose group. The overall 30-day mortality was 13 %. There was 1 death in the step-down group (4 %) compared to 13 deaths (16 %) in the intermediate-dose group. CONCLUSIONS: We observed high cure rates of PCP by treatment with intermediate-dose TMP-SMX. In addition,a step-down strategy to low-dose TMP-SMX during treatment in selected patients appears to be safe and does not compromise the outcome of treatment.","Infection,44(3): 291-299","Netherlands",2016,"Not Specified","Trimethoprim-sulfamethoxazole",null,"Adults","Mortality,Cross-Sectional","Retrospective Observational","Netherlands","Adults","Not Specified","Trimethoprim-sulfamethoxazole","Mortality,Cross-Sectional","Retrospective Observational",null,"2015:2018"]
[19,"Cregan,P.,et al. (1990). \"Comparison of four methods for rapid detection of Pneumocystis carinii in respiratory specimens.\" J Clin Microbiol 28(11): 2432-2436.",null,"Cregan,P.,et al.","Comparison of four methods for rapid detection of Pneumocystis carinii in respiratory specimens","Four stains for the detection of Pneumocystis carinii in respiratory specimens were compared for sensitivity,specificity,preparation time,and ease of interpretation. One hundred specimens were collected. Of these,50 were induced sputum specimens and 50 were bronchoalveolar lavage fluid. All specimens were stained with Diff-Quik (DQ) (a modified Giemsa stain),a quick silver stain,and direct and indirect immunofluorescence stains. A positive specimen was defined as any smear positive by two or more of the methods. Fifty-eight percent of specimens were positive. Seventy-four percent of the sputum specimens and 42% of the bronchoalveolar lavages were positive. The sensitivities for detection of P. carinii in sputum were 92% with silver stain,97% with direct immunofluorescence assay (DFA),97% with indirect immunofluorescence assay (IFA),and 92% with DQ. The sensitivities for detection in bronchoalveolar lavage were 86% with silver stain,90% with DFA,86% with IFA,and 81% with DQ. Preparation times varied from 90 min for the silver stain and IFA to 3 min for DQ. Costs of the tests varied from $1.50 per slide for DQ to $10.00 per slide for the silver stain and DFA. Reading times varied from 10 to 30 min for the silver stain and DQ to less than 5 min for the immunofluorescence assays. We conclude that all of these tests are viable options for the clinical laboratory,and the choice will be influenced by factors such as clinical volume,ability to batch specimens,and expertise of technological support. A reasonable option may be to use the quick and inexpensive DQ as a screening test and to confirm negative smears with a more sensitive assay.","J Clin Microbiol,28(11): 2432-2436","USA",1990,"Not Specified",null,null,"Unknown","Diagnostic Research","Clinical Study","USA","Unknown","Not Specified",null,"Diagnostic Research","Clinical Study",null,"1990:1994","Bronchoalveolar lavage,Sputum Induction"]
[20,"del Rio,C.,et al. (1988). \"Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.\" Arch Pathol Lab Med 112(12): 1229-1232.",null,"del Rio,C.,et al.","Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome","To examine the role of sputum examination in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS),we conducted a prospective study of 30 patients with AIDS or suspected AIDS. Sputum was obtained just prior to bronchoscopy by spontaneous cough (20 patients) or by induction with a saline nebulizer (ten patients). Pneumocystis carinii was diagnosed by bronchoalveolar lavage in 13 of the 30 patients; two of these patients had P carinii organisms identified in sputum specimens (sensitivity of sputum,15.3%; negative predictive value,60.7%). A cost-analysis study demonstrated that sputum examination is not cost effective when the sensitivity is below 24%. We conclude that P carinii can be diagnosed from expectorated sputum in patients with AIDS,but,because of the test's low sensitivity,it cannot be recommended in the routine evaluation of patients with AIDS and pulmonary complaints.","Arch Pathol Lab Med,112(12): 1229-1232","USA",1988,"AIDS",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Prospective Cohort","USA","Unknown","AIDS",null,"Diagnostic Research,Cost and Resource Use","Prospective Cohort",null,"1960:1989","Bronchoalveolar lavage,Sputum Induction"]
[21,"Desoubeaux,G.,et al. (2017). \"Use of calcofluor-blue brightener for the diagnosis of Pneumocystis jirovecii pneumonia in bronchial-alveolar lavage fluids: A single-center prospective study.\" Med Mycol 55(3): 295-301.",null,"Desoubeaux,G.,et al.","Use of calcofluor-blue brightener for the diagnosis of Pneumocystis jirovecii pneumonia in bronchial-alveolar lavage fluids: A single-center prospective study","The biological diagnosis of Pneumocystis jirovecii pneumonia (PjP) is based on the investigation of respiratory fluids by conventional staining methods and/or molecular biology. Diagnostic performance of an in-house technique based on calcofluor-blue brightener for the direct detection of P. jirovecii cysts was prospectively assessed in bronchial-alveolar lavage fluids (BALF) from patients with a suspected PjP infection over a three-year period in a single center: the diagnostic yield was compared to that of a commercial kit based on monoclonal immunofluorescence assay (IFA) on replicate smears. May-Grunwald Giemsa (MGG) staining and quantitative Polymerase Chain Reaction (qPCR) were also performed. The gold standard for each patient was the definitive diagnosis of PjP infection by an independent committee based on clinical,radiological,and biological data. Overall,481 BALF were assessed: 42 were found to be positive for the detection of P. jirovecii by at least one laboratory technique,but only 35 were actually judged to be in agreement with the definitive diagnosis of PjP infection. The sensitivity of the calcofluor-blue brightener technique was 74.3% vs. 60.0%,34.6%,and 82.9% for IFA,MGG,and qPCR,respectively; and its specificity was 99.6% vs. 99.3%,100.0%,and 99.4% for IFA,MGG,and qPCR. No technique was shown to be statistically superior to calcofluor-blue brightener. Further validation of the test through multicenter studies is now required,but in light of its low cost and easy preparation,the use of calcofluor-blue brightener in BALF appears to be a valuable alternative method for the routine first-line diagnosis of PjP infection.","Med Mycol,55(3): 295-301","France",2017,"Not Specified",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Prospective Cohort","France","Unknown","Not Specified",null,"Diagnostic Research,Cost and Resource Use","Prospective Cohort",null,"2015:2018","Bronchoalveolar lavage"]
[22,"Esteves,F.,et al. (2015). \"Diagnosis of Pneumocystis pneumonia: evaluation of four serologic biomarkers.\" Clin Microbiol Infect 21(4): 379.e371-310.",null,"Esteves,F.,et al.","Diagnosis of Pneumocystis pneumonia: evaluation of four serologic biomarkers","The diagnosis of Pneumocystis pneumonia (PCP) relies on microscopic visualization of Pneumocystis jirovecii organisms or DNA detection in pulmonary specimens. This study aimed to assess the usefulness of (1-3)-beta-d-glucan (BG),Krebs von den Lungen-6 antigen (KL-6),lactate dehydrogenase (LDH) and S-adenosyl methionine (SAM) as serologic biomarkers in the diagnosis of PCP. Serum levels of BG,KL-6,LDH and SAM were investigated in 145 Portuguese patients,50 patients from the Netherlands,25 Spanish patients and 40 Portuguese blood donors. Data on clinical presentation,chest imaging and gasometry tests were available. PCP cases were confirmed by microscopy and PCR techniques. A cost-effectiveness analysis was performed. BG was found to be the most reliable serologic biomarker for PCP diagnosis,followed by KL-6,LDH and SAM. The BG/KL-6 combination test was the most accurate serologic approach for PCP diagnosis,with 94.3% sensitivity and 89.6% specificity. Although less sensitive/specific than the reference standard classic methods based on bronchoalveolar lavage followed by microscopic or molecular detection of P. jirovecii organisms,the BG/KL-6 test may provide a less onerous procedure for PCP diagnosis,as it uses a minimally invasive and inexpensive specimen (blood),which may be also a major benefit for the patient's care. The BG/KL-6 combination test should be interpreted within the clinical context,and it may be used as a preliminary screening test in patients with primary suspicion of PCP,or as an alternative diagnostic procedure in patients with respiratory failure or in children,avoiding the associated risk of complications by the use of bronchoscopy.","Clin Microbiol Infect,21(4): 379.e371-310","Portugal,Netherlands,Spain",2015,"Not Specified",null,null,"Children","Diagnostic Research,Cost and Resource Use","Prospective Cohort","Portugal,Netherlands,Spain","Children","Not Specified",null,"Diagnostic Research,Cost and Resource Use","Prospective Cohort",null,"2015:2018","Biomarker,X-ray"]
[23,"Fatti,G. L.,et al. (2006). \"Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus.\" Int J Infect Dis 10(4): 282-285.",null,"Fatti,G. L.,et al.","Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus","BACKGROUND: Pneumocystis pneumonia (PCP) caused by Pneumocystis jiroveci is common in HIV-infected children,producing substantial morbidity and mortality. Initiation of timely,effective therapy depends on clinical identification of children with PCP. OBJECTIVE: To develop a clinical decision rule to diagnose PCP in HIV-infected children for use where diagnostic resources are limited. METHODS: Analysis of data collected during a prospective incidence study of the etiology,features,and outcome of HIV-infected children hospitalized with pneumonia. RESULTS: Four clinical variables were independently associated with a diagnosis of PCP in multivariate analysis: age < 6 months (OR 15.6; 95% CI 2.4-99.8; p = 0.004),respiratory rate > 59 breaths/min (OR 8.1; 95% CI 1.5-53.2; p = 0.018),arterial percentage hemoglobin oxygen saturation (SaO2) < or = 92% (OR 5.1; 95% CI 1.0-26.1; p = 0.052) and absence of history of vomiting (OR 11.2; 95% CI 1.9-68.0; p = 0.008). The sensitivity and specificity of diagnosing PCP with any two or more of these variables were 1.00 (95% CI 0.74-1.00) and 0.49 (95% CI 0.39-0.59),respectively. Diagnosing PCP with three or more of the indicators had a decreased sensitivity of 0.75 (95% CI 0.43-0.95) and increased specificity of 0.90 (95% CI 0.83-0.95). CONCLUSION: Empirical anti-pneumocystis therapy should be considered in HIV-infected infants presenting with tachypnea,hypoxia and absence of vomiting.","Int J Infect Dis,10(4): 282-285","South Africa",2006,"HIV",null,null,"Children","Diagnostic Research","Prospective Cohort","South Africa","Children","HIV",null,"Diagnostic Research","Prospective Cohort",null,"2005:2009","Respiratory rate,Hemoglobin oxygen saturation"]
[24,"Freedberg,K. A.,et al. (1991). \"Primary prophylaxis for Pneumocystis carinii pneumonia in HIV-infected people with CD4 counts below 200/mm3: a cost-effectiveness analysis.\" J Acquir Immune Defic Syndr 4(5): 521-531.",null,"Freedberg,K. A.,et al.","Primary prophylaxis for Pneumocystis carinii pneumonia in HIV-infected people with CD4 counts below 200/mm3: a cost-effectiveness analysis","We developed a decision-analytic model to assess the effectiveness and costs of dapsone,trimethoprim-sulfamethoxazole,or aerosolized pentamidine as initial prophylaxis for Pneumocystis carinii pneumonia in human immunodeficiency virus-infected people without prior symptoms AIDS and with CD4 counts less than 200/mm3. Each strategy increased life expectancy by about 18% compared with no prophylaxis; annual per-person costs were $440,$700,and $1,680 for dapsone,trimethoprim-sulfamethoxazole,and aerosolized pentamidine,respectively. These cost differences make a strategy beginning with dapsone most cost effective,with an incremental cost-effectiveness ratio of $13,400 per life year saved compared with no prophylaxis. Aerosolized pentamidine was substantially less cost effective,but the incremental cost effectiveness ratios were highly dependent on estimates for quality of life,efficacy,toxicity,and compliance. We conclude that,based on currently available data,initial prophylaxis with either dapsone or trimethoprim-sulfamethoxazole is most cost effective. For every 100,000 people treated,starting prophylaxis with trimethoprim-sulfamethoxazole or dapsone--with crossover to aerosolized pentamidine if oral therapy is not tolerated--may save between $98 million and $124 million per year.","J Acquir Immune Defic Syndr,4(5): 521-531","USA",1991,"AIDS","Trimethoprim-sulfamethoxazole,Pentamidine,Dapsone",null,"Unknown","Economic Model","Observational","USA","Unknown","AIDS","Trimethoprim-sulfamethoxazole,Pentamidine,Dapsone","Economic Model","Observational",null,"1990:1994"]
[25,"Freedberg,K. A.,et al. (1996). \"Validating literature-based models with direct clinical trial results: the cost-effectiveness of secondary prophylaxis for PCP in AIDS patients.\" Med Decis Making 16(1): 29-35.",null,"Freedberg,K. A.,et al.","Validating literature-based models with direct clinical trial results: the cost-effectiveness of secondary prophylaxis for PCP in AIDS patients","OBJECTIVE: To compare literature-based estimates of the cost-effectiveness ratios of strategies for secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) in AIDS patients with estimates obtained using data from a recent comparative clinical trial. DESIGN: A decision-analytic Markov model with data on drug efficacy and toxicity from both the medical literature and a national randomized clinical trial. Drug costs were from average wholesale prices. Discounted life expectancy,total direct medical costs,and cost-effectiveness were projected in dollars per year of life saved (YLS). SETTING: Hypothetical for the literature-based model,then the clinical trial results from the multicenter AIDS Clinical Trials Group (ACTG Protocol 021). PATIENT POPULATION: Patients with AIDS and a prior episode of PCP. INTERVENTIONS: Strategies included no prophylaxis,TMP-SMX (160/800 mg) daily,or aerosolized pentamidine (300 mg) monthly. Patients experiencing major toxic reactions to either medication would cross over to the other agent. MAIN RESULTS: In the literature-based model no prophylaxis was associated with a projected life expectancy of 1.430 years,and total direct cost of $42,080. TMP-SMX increased life expectancy to 2.051 years and cost to $42,300; for aerosolized pentamidine life expectancy was 2.066 years and cost $43,960. TMP-SMX had an incremental cost-effectiveness ratio of $350 per YLS compared with no prophylaxis; the incremental ratio for aerosolized pentamidine was $2,950 per YLS when compared with no prophylaxis,but rose to $110,880 per YLS compared with TMP-SMX. When data from ACTG clinical trial 021 were utilized in the model,the incremental cost-effectiveness ratio for TMP-SMX compared with no prophylaxis was $720 per YLS; aerosolized pentamidine was not cost-effective,and was \"dominated\" by TMP-SMX because it was associated with higher costs and shorter life expectancy. CONCLUSIONS: Literature-based cost-effectiveness models are useful in developing health policy before clinical trials are completed. Clinical trial results,when available,can be used to validate and revise these models. For secondary PCP prophylaxis in AIDS patients,TMP-SMX is substantially more cost-effective than aerosolized pentamidine.","Med Decis Making,16(1): 29-35","USA",1996,"AIDS","Trimethoprim-sulfamethoxazole,Pentamidine",null,"Unknown","Economic Model","Observational","USA","Unknown","AIDS","Trimethoprim-sulfamethoxazole,Pentamidine","Economic Model","Observational",null,"1995:1999"]
[26,"Gallant,J. E.,et al. (1995). \"The impact of prophylaxis on outcome and resource utilization in Pneumocystis carinii pneumonia.\" Chest 107(4): 1018-1023.",null,"Gallant,J. E.,et al.","The impact of prophylaxis on outcome and resource utilization in Pneumocystis carinii pneumonia","STUDY OBJECTIVE: Pneumocystis carinii pneumonia (PCP) is a major late complication of HIV infection associated with morbidity and mortality. Because chemoprophylaxis is highly effective,cases of PCP can be viewed as failures in the management of HIV disease. METHODS: We reviewed demographic,clinical,and cost data for all cases of confirmed HIV-related PCP at The Johns Hopkins Hospital in 1991 to determine consequences of missed prophylaxis. We also analyzed hospital discharge data for Maryland in 1991 to assess hospital charges,length of stay,and outcome for all patients with a principal diagnosis of HIV-related PCP. RESULTS: Pneumocystis carinii pneumonia was diagnosed in 79 patients. Of the 79 patients,61 (77%) did not receive prophylaxis,including 26 who were not previously known to have HIV infection,17 who did not have prophylaxis prescribed,and 18 who had prophylaxis prescribed,but were not compliant with the regimen. Patients not taking prophylaxis accounted for all 12 deaths ascribed to PCP. This group also accounted for 85% of the hospital days,100% of the ICU days,and 89% of the inpatient charges. The total hospital charges were $849,540. Extrapolation of these figures for the state of Maryland suggest that the failure to receive prophylaxis in 1991 resulted in 62 patient deaths and a cost of approximately $4.7 million. CONCLUSION: Patients who developed PCP despite prophylaxis had a better outcome and used fewer resources than patients not receiving preventive therapy. This study emphasizes the impact of PCP prophylaxis on the morbidity,mortality,and economics of HIV health care.","Chest,107(4): 1018-1023","USA",1995,"HIV",null,null,"Unknown","Cost and Resource Use,Mortality","Retrospective Observational","USA","Unknown","HIV",null,"Cost and Resource Use,Mortality","Retrospective Observational",null,"1995:1999"]
[27,"Glenny,R. W. and D. J. Pierson (1992). \"Cost reduction in diagnosing Pneumocystis carinii pneumonia. Sputum induction versus bronchoalveolar lavage as the initial diagnostic procedure.\" Am Rev Respir Dis 145(6): 1425-1428.",null,"Glenny,R. W. and D. J. Pierson","Cost reduction in diagnosing Pneumocystis carinii pneumonia. Sputum induction versus bronchoalveolar lavage as the initial diagnostic procedure","Sputum induction (SI) is a sensitive and specific method for diagnosing Pneumocystis carinii pneumonia (PCP) in patients with AIDS. Although less expensive than bronchoscopy with bronchoalveolar lavage (BAL),SI followed by BAL does not necessarily reduce costs compared with BAL alone. Cost analysis demonstrates that the cost of diagnosing PCP is dependent on the prevalence of PCP (PCPprevalence) in the studied population,the sensitivity of SI (SIsensitivity) for diagnosing PCP,and the relative costs of SI and BAL (SIcost and BALcost) for diagnosing PCP. In any given clinical setting,SI reduces the cost of diagnosing PCP if (PCPprevalence)(SIsensitivity) greater than SIcost/BALcost. A graphic approach relating these parameters is also presented. Evaluation of reported PCPprevalence and SIsensitivity from recent literature illustrates that SI is not always the least costly method for diagnosing PCP. Cost reduction is not the only measure of a diagnostic procedure's value,and other aspects,such as discomfort,availability,risks,and patient prognosis,must be considered. The cost analysis approach used in this study identifies those variables that can be manipulated to reduce the cost of diagnosing PCP.","Am Rev Respir Dis,145(6): 1425-1428","USA",1992,"AIDS",null,null,"Unknown","Cost and Resource Use,Diagnostic Research","Narrative Review","USA","Unknown","AIDS",null,"Cost and Resource Use,Diagnostic Research","Narrative Review",null,"1990:1994","Bronchoalveolar lavage,Sputum Induction"]
[28,"Goldie,S. J.,et al. (2002). \"Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelines.\" Arch Intern Med 162(8): 921-928.",null,"Goldie,S. J.,et al.","Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelines","BACKGROUND: Human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) have experienced a dramatic decrease in Pneumocystis carinii pneumonia (PCP),necessitating reassessment of clinical guidelines for prophylaxis. METHODS: A simulation model of HIV infection was used to estimate the lifetime costs and quality-adjusted life expectancy (QALE) for alternative CD4 cell count criteria for stopping primary PCP prophylaxis in patients with CD4 cell count increases receiving HAART and alternative agents for second-line PCP prophylaxis in those intolerant of trimethoprim-sulfamethoxazole (TMP/SMX). The target population was a cohort of HIV-infected patients in the United States with initial CD4 cell counts of 350/microL who began PCP prophylaxis after their first measured CD4 lymphocyte count less than 200/microL. Data were from randomized controlled trials and other published literature. RESULTS: For patients with CD4 cell count increases during HAART,waiting to stop prophylaxis until the first observed CD4 cell count was greater than 300/microL prevented 9 additional cases per 1000 patients and cost $9400 per quality-adjusted life year (QALY) gained compared with stopping prophylaxis at 200/microL. For patients intolerant of TMP/SMX,using dapsone increased QALE by 2.7 months and cost $4500 per QALY compared with no prophylaxis. Using atovaquone rather than dapsone provided only 3 days of additional QALE and cost more than $1.5 million per QALY. CONCLUSIONS: Delaying discontinuation of PCP prophylaxis until the first observed CD4 cell count greater than 300/microL is cost-effective and provides an explicit \"PCP prophylaxis stopping criterion.\" In TMP/SMX-intolerant patients,dapsone is more cost-effective than atovaquone.","Arch Intern Med,162(8): 921-928","USA",2002,"HIV","Atovaquone,Dapsone,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model","Observational","USA","Unknown","HIV","Atovaquone,Dapsone,Trimethoprim-sulfamethoxazole","Economic Model","Observational",null,"2000:2004"]
[29,"Harris,J. R.,et al. (2011). \"Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP).\" PLoS One 6(8): e23158.",null,"Harris,J. R.,et al.","Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP)","BACKGROUND: Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging,particularly in developing countries. Highly sensitive diagnostic methods are costly,while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. METHODS AND FINDINGS: We compared cost-effectiveness,as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated,of 33 PCP diagnostic options,involving combinations of specimen collection methods [oral washes,induced and expectorated sputum,and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)],or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory,HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence,diagnostic procedures involving expectorated sputum with any PCR method,or induced sputum with nested or real-time PCR,were all highly cost-effective,successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit,successfully treating 68-90% of patients at costs of $189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained,successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients,though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options. CONCLUSIONS: For diagnosis of PCP,use of PCR technologies,when combined with less-invasive patient specimens such as expectorated or induced sputum,represent more cost-effective options than any diagnostic procedure using BAL,or chest x-ray alone.","PLoS One,6(8): e23158","USA",2011,"HIV",null,null,"Unknown","Economic Model,Diagnostic Research","Clinical Study","USA","Unknown","HIV",null,"Economic Model,Diagnostic Research","Clinical Study",null,"2010:2014","Specimen Collection,Laboratory Procedure,X-ray"]
[30,"Hibberd,P. L.,et al. (1992). \"Trimethoprim-sulfamethoxazole compared with ciprofloxacin for the prevention of urinary tract infection in renal transplant recipients. A double-blind,randomized controlled trial.\" Online J Curr Clin Trials Doc No 15: [4083 words; 4046 paragraphs].",null,"Hibberd,P. L.,et al.","Trimethoprim-sulfamethoxazole compared with ciprofloxacin for the prevention of urinary tract infection in renal transplant recipients. A double-blind,randomized controlled trial","BACKGROUND: Prophylaxis with low-dose trimethoprim-sulfamethoxazole has been shown to be cost-effective in the prevention of urinary tract infections,pyelonephritis,urosepsis,and pneumocystis pneumonia in renal transplant recipients. Ciprofloxacin,effective against almost all urinary tract pathogens in this patient population,represents a promising alternative prophylactic agent for patients unable to tolerate trimethoprim-sulfamethoxazole due to toxicity. METHODS: We conducted a randomized,double-blind trial to compare low-dose trimethoprim-sulfamethoxazole with ciprofloxacin for the prevention of urinary tract infections in renal transplant recipients. Patients received either ciprofloxacin (250 mg) or trimethoprim-sulfamethoxazole (80 mg trimethoprim,400 mg sulfamethoxazole) daily for 6 months following transplantation. Treatment was considered successful if patients completed the 6-month course and 3-month follow-up period without evidence of urinary tract infection or drug-related toxicities. RESULTS: Of 103 eligible patients,51 received ciprofloxacin and 52 received trimethoprim-sulfamethoxazole. At 6 months,treatment was successful in 75% (38 of 51) receiving ciprofloxacin and 71% (37 of 52) treated with trimethoprim-sulfamethoxazole (P = 0.87,relative risk 1.04,95% confidence limits 0.83 to 1.33). Thirteen patients (25%) receiving trimethoprim-sulfamethoxazole withdrew from the study-4 for resistant urinary tract infection and 9 for drug-related toxicity,while 3 (6%) of the patients receiving ciprofloxacin withdrew because of drug-related toxicity (P = 0.016,relative risk of urinary tract infection or adverse event 0.24,95% confidence limits 0.07 to 0.78). At 9 months,all 38 patients who completed the 6-month course of ciprofloxacin remained free of urinary tract infection,while an additional 4 patients who had received trimethoprim-sulfamethoxazole prophylaxis (total of 8 patients over the 9 months) developed urinary tract infections (P = 0.006,Fisher's exact test for urinary tract infection alone). Pneumocystis pneumonia occurred in a total of 7 (14%) patients who were randomized to ciprofloxacin,but 2 of the 7 had withdrawn from the study at least 2 weeks prior to the diagnosis of pneumocystis pneumonia. There were no cases of pneumocystis pneumonia in patients receiving trimethoprim-sulfamethoxazole (P = 0.006). Following completion of the study,monthly aerosolized pentamidine administered in conjunction with ciprofloxacin has provided complete protection against urinary tract infection and pneumocystis pneumonia in 30 transplant recipients unable to tolerate trimethoprim-sulfamethoxazole therapy. CONCLUSIONS: Ciprofloxacin is at least as effective as trimethoprim-sulfamethoxazole in the prevention of urinary tract infection in renal transplant recipients,and is better tolerated. Ciprofloxacin prophylaxis is associated with a higher incidence of pneumocystis pneumonia than is trimethoprim-sulfamethoxazole therapy. An uncontrolled follow-up study suggests that ciprofloxacin prophylaxis combined with monthly aerosolized pentamidine may be efficacious in preventing both urinary tract infection and pneumocystis pneumonia in renal transplant recipients.","Online J Curr Clin Trials,Doc No 15([4083 words; 4046 paragraphs]","USA",1992,"Not Specified","Trimethoprim-sulfamethoxazole,Ciprofloxacin",null,"Unknown","Mortality","RCT","USA","Unknown","Not Specified","Trimethoprim-sulfamethoxazole,Ciprofloxacin","Mortality","RCT",null,"1990:1994"]
[31,"Hoover,D. R. (1995). \"The effects of long term zidovudine therapy and Pneumocystis carinii prophylaxis on HIV disease. A review of the literature.\" Drugs 49(1): 20-36.",null,"Hoover,D. R.","The effects of long term zidovudine therapy and Pneumocystis carinii prophylaxis on HIV disease. A review of the literature","Two lines of attack have been used against HIV-1 disease: (1) antiretroviral therapy (notably zidovudine) directed against the HIV-1 virus; and (2) chemoprophylaxis against end-stage diseases of HIV-1 infection,most notably against Pneumocystis carinii pneumonia. Many studies and clinical trials have found that zidovudine and P. carinii prophylaxis each significantly reduce short term morbidity and mortality from HIV-1 disease. However,these drugs have costs,adverse effects and (particularly with zidovudine) cumulative toxicity that suggest that their long term benefits may not necessarily be as great as their short term prospects. Due to the pressing needs of the HIV-1 epidemic,social considerations and proven short term benefits,long term clinical trials of zidovudine and P. carinii prophylaxis employing untreated control groups are impossible. Thus,the long term benefits of these anti-AIDS therapies must be estimated from observational studies comparing those who choose to use those therapies and those who do not. Strong epidemiological biases and common statistical misanalyses of observational data occur,leading to seemingly contradictory results. On the basis of the aggregate of short term clinical data and long term observational studies,zidovudine therapy taken either before or after AIDS delays the date of death by 12 months. If zidovudine therapy is initiated before AIDS,it may delay the date of diagnosis of AIDS by 12 months. However,issues of cost effectiveness,detrimental effects and optimal time to begin zidovudine therapy remain unresolved. Limited observational study data suggest that P. carinii prophylaxis initiated before the onset of clinical AIDS will delay both the date of diagnosis of AIDS and the date of death by 9 months in North American men. The net benefits from P. carinii prophylaxis will be less in those who begin this treatment after a diagnosis of AIDS. Benefits from P. carinii prophylaxis will also probably be less in regions outside of North America,in particular underdeveloped countries,where P. carinii pneumonia is less common as an end-stage HIV-1-related illness.","Drugs,49(1): 20-36","USA",1995,"HIV,AIDS","Zidovudine",null,"Unknown","Cost and Resource Use,Mortality","Narrative Review","USA","Unknown","HIV,AIDS","Zidovudine","Cost and Resource Use,Mortality","Narrative Review",null,"1995:1999"]
[32,"Horner,R. D.,et al. (1996). \"Predictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care.\" J Acquir Immune Defic Syndr Hum Retrovirol 12(4): 379-385.",null,"Horner,R. D.,et al.","Predictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care","To determine whether patient and hospital characteristics were significantly associated with variations in Pneumocystis carinii (PCP) care and outcomes,we analyzed the use of diagnostic tests,intensive care units (ICUs),anti-PCP medications for persons hospitalized with human immunodeficiency virus (HIV)-related PCP,and hospital discharge status. We conducted retrospective chart reviews of a cohort of 2,174 patients with PCP hospitalized in 1987-1990. Outcomes included process of care for PCP and in-hospital mortality rates. Persons with PCP who were more severely ill at admission were more likely to have early medical care,to receive care in an intensive care unit,and to die in hospital. After we adjusted for differences in this severity of illness,we noted that Medicaid patients,injection drug users (IDUs),and patients treated at VA or county hospitals were significantly less likely than others to have diagnostic bronchoscopies and that persons covered by Medicaid,with a previous diagnosis of acquired immunodeficiency syndrome (AIDS),who did not receive prior zidovudine (AZT) or who received care in a VA hospital had the highest chances of in-hospital death. Insurance and risk group characteristics,severity of illness,and hospital characteristics appear to be the most important determinants of the intensity and timing of medical care and outcomes among patients hospitalized with PCP.","J Acquir Immune Defic Syndr Hum Retrovirol,12(4): 379-385","USA",1996,"HIV,AIDS","Zidovudine",null,"Unknown","Cost and Resource Use,Mortality","Retrospective Observational","USA","Unknown","HIV,AIDS","Zidovudine","Cost and Resource Use,Mortality","Retrospective Observational",null,"1995:1999"]
[33,"Hughes,W. T. (1998). \"Use of dapsone in the prevention and treatment of Pneumocystis carinii pneumonia: a review.\" Clin Infect Dis 27(1): 191-204.",null,"Hughes,W. T.","Use of dapsone in the prevention and treatment of Pneumocystis carinii pneumonia: a review","Dapsone,with or without trimethoprim or pyrimethamine,has strong anti-Pneumocystis carinii activity,as demonstrated by in vitro methods,animal studies,and clinical trials. The drug blocks folic acid synthesis of P. carinii by inhibition of dihydropteroate synthetase activity. Dapsone is efficiently absorbed (70%-80%) from the gastrointestinal tract,reaches peak serum concentration in 2-6 hours,and is adequately distributed to the fluid of the alveolar spaces. Synergistic effects against P. carinii are noted when trimethoprim is combined with dapsone. This combination is recommended for therapeutic use for P. carinii pneumonia (PCP) as an alternative for patients who cannot take trimethoprim-sulfamethoxazole (TMP-SMZ). Evidence from more than 40 studies of dapsone as prophylaxis for PCP in AIDS patients shows that dapsone,either alone or in combination with pyrimethamine,is as effective as aerosolized pentamidine or atovaquone but slightly less effective than TMP-SMZ. Adverse effects include rash,anemia,methemoglobinemia,agranulocytosis,and hepatic dysfunction. Desensitization can be accomplished with many cases. Dapsone is the most cost-effective prophylaxis currently available for PCP.","Clin Infect Dis,27(1): 191-204","USA",1998,"AIDS","Dapsone",null,"Unknown","Cost and Resource Use,Mortality","Narrative Review","USA","Unknown","AIDS","Dapsone","Cost and Resource Use,Mortality","Narrative Review",null,"1995:1999"]
[34,"Hughes,W. T.,et al. (1987). \"Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis.\" N Engl J Med 316(26): 1627-1632.",null,"Hughes,W. T.,et al.","Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis","We conducted a prospective,randomized clinical trial over a two-year period in patients with acute lymphocytic leukemia to assess the effectiveness of trimethoprim-sulfamethoxazole given on three consecutive days each week as compared with daily in the prevention of Pneumocystis carinii pneumonitis. P. carinii pneumonitis did not develop in any of 92 patients receiving the drug daily (30,602 patient-days) or in any of 74 who received it three consecutive days a week (27,329 patient-days),whereas the incidence of the infection expected without prophylaxis is 21 percent. One patient,excluded from both groups because of an adverse reaction to sulfonamides in the past,acquired P. carinii pneumonitis. Especially noteworthy was a difference in the occurrence of systemic mycoses,with 10 cases in the daily-treatment group and only 1 case in the three-days-a-week group (P = 0.024). No differences were observed in the rates of other infections or adverse effects associated with the drug. We conclude that trimethoprim-sulfamethoxazole is as effective given three days a week as it is given daily in the prevention of P. carinii pneumonitis and that the intermittent schedule has the advantages of less frequent fungal infections and lower cost. Intermittent chemoprophylaxis may be especially beneficial to certain patients who are unable to tolerate the daily doses.","N Engl J Med,316(26): 1627-1632","Unknown",1987,"Not Specified","Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT","Unknown","Unknown","Not Specified","Trimethoprim-sulfamethoxazole","Mortality","RCT",null,"1960:1989"]
[35,"Jacobson, L. P., et al. (1993). \"Changes in survival after acquired immunodeficiency syndrome (AIDS): 1984-1991.\" Am J Epidemiol 138(11): 952-964.",null,"Jacobson, L. P., et al.","Changes in survival after acquired immunodeficiency syndrome (AIDS): 1984-1991","In a prospective cohort of 2,647 human immunodeficiency virus type 1 (HIV-1) seropositive homosexual men enrolled in Baltimore, Chicago, Los Angeles, and Pittsburgh, 891 developed clinical acquired immunodeficiency syndrome (AIDS) between June 1984 and January 1992. Cox proportional hazards models were used to examine temporal trends in survival after AIDS for specific diagnoses, controlling for level of immunosuppression at diagnosis, age, race, and geographic location. Median survival time following AIDS onset increased from 11.6 months in 1984-1985 to 19.5 months in 1988-1989; for those diagnosed in 1990-1991, the median survival time dropped to 17.2 months. Trends in improved survival were diagnosis-specific. Survival after Pneumocystis carinii pneumonia consistently improved from 1984 to 1991 (p < 0.001). Compared with men diagnosed in 1984-1985, those diagnosed with P. carinii pneumonia in 1990-1991 had one-tenth the hazard of dying. For men with > or = 100 helper T-lymphocytes (CD4+ cells) when diagnosed with Kaposi's sarcoma, the relative hazards (95% confidence intervals) of dying after Kaposi's sarcoma were 0.8 (0.42-1.60) in 1986-1987, 0.7 (0.34-1.58) in 1988-1989, and 0.6 (0.19-1.61) in 1990-1991 compared with those diagnosed before 1986. Men with < 100 CD4+ cells when diagnosed with Kaposi's sarcoma did not demonstrate a consistent change in their subsequent survival. After a nonsignificant (p > 0.05) initial improvement in prognosis, there has not been a significant improvement in survival for men who presented with other opportunistic infections. Observed increases in overall survival probably relate to improved treatment of patients who develop P. carinii pneumonia. Limited improvement in survival following other AIDS diagnoses indicates the need for developing effective treatment against these diseases.","Am J Epidemiol, 138(11): 952-964","USA",1993,"AIDS",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort","USA","Unknown","AIDS",null,"Mortality,Cross-Sectional","Prospective Cohort",null,"1990:1994"]
[36,"Jensen, L., et al. (2010). \"Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania.\" BMC Infect Dis 10: 140.",null,"Jensen, L., et al.","Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania","BACKGROUND: In tuberculosis (TB) endemic parts of the world, patients with pulmonary symptoms are managed as \"smear-negative TB patients\" if they do not improve on a two-week presumptive, broad-spectrum course of antibiotic treatment even if they are TB microscopy smear negative. These patients are frequently HIV positive and have a higher mortality than smear-positive TB patients. Lack of access to diagnose Pneumocystis jirovecii pneumonia might be a contributing reason. We therefore assessed the prevalence of P. jirovecii by PCR in oral wash specimens among TB patients and healthy individuals in an HIV- and TB-endemic area of sub-Saharan Africa. METHODS: A prospective study of 384 patients initiating treatment for sputum smear-positive and smear-negative TB and 100 healthy household contacts and neighbourhood controls. DNA from oral wash specimens was examined by PCR for P. jirovecii. All patients delivered sputum for TB microscopy and culture. Healthy contacts and community controls were clinically assessed and all study subjects were HIV tested and had CD4 cell counts determined. Clinical status and mortality was assessed after a follow-up period of 5 months. RESULTS: 384 patients and 100 controls were included, 53% and 8% HIV positive respectively. A total number of 65 patients and controls (13.6%) were at definitive risk for PCP based on CD4 counts <200 cells per mm3 and no specific PCP prophylaxis. Only a single patient (0.3% of the patients) was PCR positive for P. jirovecii. None of the healthy household contacts or neighbourhood controls had PCR-detectable P. jirovecii DNA in their oral wash specimens regardless of HIV-status. CONCLUSIONS: The prevalence of P. jirovecii as detected by PCR on oral wash specimens was very low among TB patients with or without HIV and healthy individuals in Tanzania. Colonisation by P. jirovecii was not detected among healthy controls. The present findings may encourage diagnostic use of this non-invasive method.","BMC Infect Dis, 10(140","Tanzania",2010,"HIV,TB",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort","Tanzania","Unknown","HIV,TB",null,"Mortality,Cross-Sectional","Prospective Cohort",null,"2010:2014"]
[37,"Kemper, C. A., et al. (1990). \"Low-dose dapsone prophylaxis of Pneumocystis carinii pneumonia in AIDS and AIDS-related complex.\" Aids 4(11): 1145-1148.",null,"Kemper, C. A., et al.","Low-dose dapsone prophylaxis of Pneumocystis carinii pneumonia in AIDS and AIDS-related complex","The efficacy, toxicity and cost of orally administered dapsone (50-100 mg/day) for prophylaxis of Pneumocystis carinii pneumonia (PCP) were evaluated in 30 patients with AIDS or AIDS-related complex (ARC). Six patients received primary and 24 secondary prophylaxis. Ten patients received a maximum dose of 100 mg/day and 20 a maximum of 50 mg/day for a median duration of 19 weeks; 22 of the 30 patients continue to receive prophylaxis as of May 1989. Four patients have died, none of pneumocystis infection. One patient with AIDS suffered a mild relapse while receiving 50 mg/day. Hematologic toxicity was mild and could not be definitively attributed to dapsone therapy; rash due to dapsone was documented in two patients. A review of 33 patients at our institution with a history of PCP who received no prophylaxis demonstrated seven relapses, three of which were fatal. Cost analysis revealed a significant advantage for oral dapsone over aerosolized pentamidine.","Aids, 4(11): 1145-1148","USA",1990,"AIDS","Dapsone",null,"Unknown","Mortality,Cost and Resource Use,Cross-Sectional","Retrospective Observational","USA","Unknown","AIDS","Dapsone","Mortality,Cost and Resource Use,Cross-Sectional","Retrospective Observational",null,"1990:1994"]
[38,"Low, A., et al. (2016). \"Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.\" Clin Infect Dis 62(12): 1595-1603.",null,"Low, A., et al.","Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis","BACKGROUND: To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected adults in low- and middle-income countries (LMICs). METHODS: Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count >/=200 cells/microL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case. RESULTS: We identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%-91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval [CI], 828 032-874 853), with cost savings of $46.7 million (95% CI, $43.8-$49.4 million). CONCLUSIONS: There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted.","Clin Infect Dis, 62(12): 1595-1603","UK,Switzerland,Canada,USA",2016,"HIV,AIDS","Antiretroviral therapy",null,"Unknown","Mortality,Epidemiology","Systematic Review","UK,Switzerland,Canada,USA","Unknown","HIV,AIDS","Antiretroviral therapy","Mortality,Epidemiology","Systematic Review",null,"2015:2018"]
[39,"Lundgren, J. D., et al. (1995). \"Changes in survival over time after a first episode of Pneumocystis carinii pneumonia for European patients with acquired immunodeficiency syndrome. Multicentre Study Group on AIDS in Europe.\" Arch Intern Med 155(8): 822-828.",null,"Lundgren, J. D., et al.","Changes in survival over time after a first episode of Pneumocystis carinii pneumonia for European patients with acquired immunodeficiency syndrome. Multicentre Study Group on AIDS in Europe","BACKGROUND: Factors associated with improved survival over time for patients with the acquired immunodeficiency syndrome (AIDS) who have Pneumocystis carinii pneumonia at diagnosis are not clearly defined. METHODS: An inception cohort of 2533 patients with AIDS, diagnosed from 1979 to 1989, from 52 centers in 17 European countries was studied. Survival 3 months and 3 years after diagnosis was estimated by Kaplan-Meier life tables. Independent predictors of survival were analyzed by construction of Cox proportional hazards models. RESULTS: Patients in whom AIDS and P carinii pneumonia had been diagnosed before 1988 had a poorer 3-month (ie, short-term) survival, whereas the survival 1 and 2 years after P carinii pneumonia was lower only for patients whose disease was diagnosed before 1987 compared with those with more recent diagnoses. Other variables associated with poorer outcome were greater age, infection via blood transfusion, diagnosis made in south Europe, and coexisting illnesses. After controlling for these prognostic markers in multivariate analysis, improvement in survival over time was still evident. For patients who survived the P carinii pneumonia episode, both zidovudine and secondary prophylaxis for P carinii pneumonia initiated around the time of diagnosis were associated with improved survival, and, after controlling for these treatment variables, no statistically significant improvement in survival over time was observed. CONCLUSIONS: Survival after an episode of P carinii pneumonia has improved within recent years. Increased awareness of early symptoms of P carinii pneumonia and better treatment of the pneumonia may have led to improvement in short-term survival over time, whereas the introduction of zidovudine and increased use of secondary P carinii pneumonia prophylaxis may have resulted in the recent increase in survival 1 and 2 years after the diagnosis. However, 3-year survival remained unchanged over time, implying that the underlying human immunodeficiency virus infection and other complications are not effectively controlled.","Arch Intern Med, 155(8): 822-828","Europe",1995,"AIDS","Zidovudine",null,"Unknown","Mortality,Epidemiology,Cross-Sectional","Retrospective Observational","Europe","Unknown","AIDS","Zidovudine","Mortality,Epidemiology,Cross-Sectional","Retrospective Observational",null,"1995:1999"]
[40,"Machen, H. E., et al. (2015). \"Outcomes of Patients with Respiratory Distress Treated with Bubble CPAP on a Pediatric Ward in Malawi.\" J Trop Pediatr 61(6): 421-427.",null,"Machen, H. E., et al.","Outcomes of Patients with Respiratory Distress Treated with Bubble CPAP on a Pediatric Ward in Malawi","OBJECTIVE: To describe the outcomes of infants and young children with respiratory distress when treated with a novel, low-cost, stand-alone bubble Continuous Positive Airway Pressure (bCPAP) system in a resource-limited setting. METHODS: A non-randomized, convenience sample study in a pediatric unit in Blantyre, Malawi, 2013. Patients weighing </=10 kg with respiratory distress were eligible. We compared outcomes for patients with bronchiolitis, pneumonia and Pneumocystis jiroveci pneumonia (PJP) after treatment with bCPAP. RESULTS: Seventy percent of patients treated with bCPAP survived. Outcomes were best for patients with bronchiolitis and worst for those with PJP. Most survivors (80%) showed improvement within 24 h. All treating physicians found bCPAP useful, leading to a change in practice. CONCLUSIONS: Bubble CPAP was most beneficial to patients with bronchiolitis. Children, who were going to get well, tended to get well quickly. Physicians believed the bCPAP system provided a higher level of care than nasal oxygen.","J Trop Pediatr, 61(6): 421-427","Malawi",2015,"Not Specified","Bubble CPAP",null,"Children","Mortality,Cross-Sectional","Prospective Cohort","Malawi","Children","Not Specified","Bubble CPAP","Mortality,Cross-Sectional","Prospective Cohort",null,"2015:2018"]
[41,"Mansharamani, N. G., et al. (2000). \"Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states.\" Chest 118(3): 704-711.",null,"Mansharamani, N. G., et al.","Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states","STUDY OBJECTIVES: Encompassing periods preceding and following major advances in the diagnosis and management of HIV-related Pneumocystis carinii pneumonia (PCP), the purpose of this study was to determine whether management and outcome patterns of non-HIV PCP parallel the management and outcomes of AIDS-related PCP. DESIGN: Retrospective review of medical records. SETTING: A 375-bed tertiary-care urban teaching hospital and referral center. PATIENTS: All adult patients with morphologically confirmed PCP from 1985 to 1995. MEASUREMENTS AND RESULTS: From 1985 to 1995, 638 confirmed cases of PCP were identified, including 605 cases in 442 HIV-positive persons (HIV + PCP), and 33 cases in 33 non-HIV patients (non-HIV PCP). For HIV + PCP cases, a peak of 104 cases occurred in 1987, with a gradual decline to 23 in 1995. The proportion of cases requiring hospitalization declined from a peak of 91.6% in 1987 to a low of 51.6% in 1992. ICU admission was required for 6.3 to 8.2%, and mechanical ventilation for 4.7 to 5.7%. Overall mortality improved from 11.7 to 6.6%, although mortality for intubated patients remained at 50 to 60%. For the non-HIV PCP cases, 97% occurred from 1989 to 1995 with similar annual frequency, 97% required hospitalization, 69% required ICU admission, and 66% required intubation. Overall mortality was 39%, and mortality for intubated patients was 59%. CONCLUSIONS: Despite major advances in diagnosis and management, PCP remains a significant problem in non-HIV-infected patients, and respiratory failure remains associated with a high mortality rate for patients with both HIV + PCP and non-HIV PCP.","Chest, 118(3): 704-711","USA",2000,"HIV,Immunocompromised",null,null,"Adults","Mortality,Cross-Sectional","Retrospective Observational","USA","Adults","HIV,Immunocompromised",null,"Mortality,Cross-Sectional","Retrospective Observational",null,"2000:2004"]
[42,"May, T., et al. (1994). \"Trimethoprim-sulfamethoxazole versus aerosolized pentamidine for primary prophylaxis of Pneumocystis carinii pneumonia: a prospective, randomized, controlled clinical trial. LFPMI Study Group. Ligue Francaise de Prevention des Maladies Infectieuses.\" J Acquir Immune Defic Syndr 7(5): 457-462.",null,"May, T., et al.","Trimethoprim-sulfamethoxazole versus aerosolized pentamidine for primary prophylaxis of Pneumocystis carinii pneumonia: a prospective, randomized, controlled clinical trial. LFPMI Study Group. Ligue Francaise de Prevention des Maladies Infectieuses","The objective was to compare the efficacy and tolerance of monthly aerosolized pentamidine versus trimethoprim-sulfamethoxazole (TMP-SMX) to prevent the first episode of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients. In an open, prospective, randomized multicentric clinical trial, HIV-infected patients (n = 214) with CD4 cell counts < 200/mm3 or 20% without a history of PCP or cerebral toxoplasmosis were randomized to receive for at least 2 years aerosolized pentamidine (300 mg monthly) or low-dose daily TMP-SMX (400-80 mg). The mean follow-up was 578 days. The two groups (except for gender) were homogeneous for age, risk group for HIV infection, initial CD4+ lymphocyte count, and mean follow-up. The PCP rate per year of observation using an intent-to-treat analysis was 3.1% and 1.3% in the groups treated with pentamidine and TMP-SMX, respectively (p > 0.05). Moderate or severe clinical and biological side effects were observed in five patients on pentamidine and 33 on TMP-SMX (p < 0.05). Nineteen episodes of cerebral toxoplasmosis were diagnosed during the study. The analysis showed no significant difference in time of development of toxoplasmosis, but only one patient was actually treated with TMP-SMX. Survival was not significantly different in the two groups. Low-dose daily TMP-SMX or monthly aerosolized pentamidine effectively prevented a first episode of PCP in HIV-infected patients, but aerosolized pentamidine was better tolerated. However, TMP-SMX is less costly and should have a preventive effect for toxoplasmosis.","J Acquir Immune Defic Syndr, 7(5): 457-462","France",1994,"HIV","Trimethoprim-sulfamethoxazole,Pentamidine",null,"Unknown","Mortality","RCT","France","Unknown","HIV","Trimethoprim-sulfamethoxazole,Pentamidine","Mortality","RCT",null,"1990:1994"]
[43,"Metersky, M. L., et al. (1992). \"Lack of utility of bronchial brush biopsy in patients infected with the human immunodeficiency virus.\" Chest 101(3): 680-683.",null,"Metersky, M. L., et al.","Lack of utility of bronchial brush biopsy in patients infected with the human immunodeficiency virus","While bronchoalveolar lavage has been shown to be more sensitive than brush biopsy (BB) for the diagnosis of Pneumocystis carinii pneumonia in AIDS patients, some have reported that BB occasionally is positive in spite of a negative BAL. Many bronchoscopists, therefore, continue to perform routine BB when doing bronchoscopy on AIDS patients. We performed a retrospective study of all fiberoptic bronchoscopies done on human immunodeficiency virus-infected patients over a one-year period at our institution to determine if the use of BB added to the diagnostic yield of bronchoscopy over that of BAL alone. Of 84 bronchoscopies in which BB was performed in addition to BAL, BB yielded no diagnoses that were not obtained by BAL. Brush biopsy added approximately $400 to the cost of bronchoscopy. We conclude that BB should not be routinely done when performing bronchoscopy on HIV-infected patients.","Chest, 101(3): 680-683","USA",1992,"AIDS",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Retrospective Observational","USA","Unknown","AIDS",null,"Diagnostic Research,Cost and Resource Use","Retrospective Observational",null,"1990:1994","Brush biopsy"]
[44,"Narasimha, P. D., et al. (2004). \"Role of multiple induced sputum examination in the diagnosis of Pneumocystis carinii pneumonia.\" Southeast Asian J Trop Med Public Health 35(3): 702-704.",null,"Narasimha, P. D., et al.","Role of multiple induced sputum examination in the diagnosis of Pneumocystis carinii pneumonia","We evaluated the usefulness of repeated nebulized saline induced sputum examinations among 60 HIV infected patients clinically suspected to have Pneumocystis carinii pneumonia (PCP). We found that the first sample was positive for 15 episodes (21.4%); the second sample was positive in 33 episodes (47.1%); the third sample was positive in 22 episodes (31.4%). Repeated nebulized saline induced sputum examination imporved the yield of Pneumocystis carinii and enhanced the sensitivity of a positive result. This technique is simple, cost-effective, non-invasive, and reliable. We recommend the examination of multiple induced samples of nebulized saline induced sputum in all HIV infected patients with suspected PCP. This recommendation may decrease the need for invasive procedures.","Southeast Asian J Trop Med Public Health, 35(3): 702-704","India",2004,"HIV",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Clinical Study","India","Unknown","HIV",null,"Diagnostic Research,Cost and Resource Use","Clinical Study",null,"2000:2004","Sputum Induction"]
[45,"Nassar, A., et al. (2006). \"Utility of reflex Gomori methenamine silver staining for Pneumocystis jirovecii on bronchoalveolar lavage cytologic specimens: a review.\" Diagn Cytopathol 34(11): 719-723.",null,"Nassar, A., et al.","Utility of reflex Gomori methenamine silver staining for Pneumocystis jirovecii on bronchoalveolar lavage cytologic specimens: a review","Pneumocystis jiroveci (Pj; formerly Pneumocystis carinii) is an opportunistic pathogen causing life-threatening pneumonia (Pneumocystis pneumonia) in immunosuppressed individuals. Its diagnosis is dependent on identification in bronchoalveolar lavage (BAL) specimens. Gomori's methenamine silver nitrate (GMS) stain has been advocated to highlight the organisms in BAL specimens. This study was performed to determine the utility of reflex GMS staining on all BAL specimens for identifying Pj.All BAL specimens from years 2000 to 2004 were processed as cytospins and stained with Papanicolaou (Pap) and GMS stains. A total of 2,984 BAL specimens were identified. A total of 116 (3.9% of total BAL) BAL specimens were diagnostic of Pj. The diagnostic specimens were grouped as follows: 103 (88.8% of total positive cases) Pj identified with both Pap and GMS staining; 11 (9.5% of total positive cases) Pj identified only with Pap staining; and 2 (1.7% of total positive cases) Pj identified only with GMS staining. In conclusion, the prevalence of Pj in BAL specimens is 3.9%, which can be attributed to improved management of immunocompromised patients. Performing reflex GMS staining on all BAL specimens does not improve the diagnostic identification of Pj since the majority (98.3%) of diagnoses can be rendered on Pap stained slides. A cost analysis for GMS staining on 2,879 GMS-negative BAL specimens was estimated at $143,950. Thus, from diagnostic and cost benefit perspectives, GMS staining can be recommended only on cases where Pap stain is negative, and the clinical presentation is consistent with Pneumocystis pneumonia.","Diagn Cytopathol, 34(11): 719-723","USA",2006,"Not Specified",null,null,"Unknown","Diagnostic Research,Cost and Resource Use","Narrative Review","USA","Unknown","Not Specified",null,"Diagnostic Research,Cost and Resource Use","Narrative Review",null,"2005:2009"]
[46,"Nicolau, D. P., et al. (1996). \"Pharmacoeconomics of Pneumocystis carinii pneumonia in HIV-infected and HIV-noninfected patients.\" Pharmacoeconomics 10(1): 72-78.",null,"Nicolau, D. P., et al.","Pharmacoeconomics of Pneumocystis carinii pneumonia in HIV-infected and HIV-noninfected patients","Despite the proven effectiveness of Pneumocystis carinii pneumonia (PCP) prophylaxis in both HIV-infected and HIV-noninfected patients, PCP remains an important cause of serious pulmonary infection. Because PCP is a frequent event requiring inpatient admission at our institution, we conducted a study to define the pharmacoeconomics of this infection and the incidence of adverse events associated with anti-PCP therapy. In a retrospective review, 133 patients (101 HIV-positive, 32 HIV-negative) with documented PCP were identified. Significant differences in age, initial arterial oxygen tension (paO2), intensive care unit admission and mortality were evident between HIV-infected and non-HIV-infected patients; however, there were no differences in the duration of hospitalisation or the duration of anti-PCP therapy. The incidence of biochemical abnormalities was similar between the groups. Leucopenia occurred at an incidence of 52 and 31%, while thrombocytopenia occurred at a rate of 7 and 44%, in HIV-positive and HIV-negative patients, respectively. Drug toxicity or treatment failure necessitated a change of therapy in 43% of HIV-positive and 59% of HIV-negative patients. PCP treatment cost, pharmacy cost, hospital cost and net loss (i.e. the difference between hospital cost and reimbursement) were all significantly greater in HIV-negative than in HIV-positive patients. The duration of anti-PCP therapy and the hospital cost for cotrimoxazole (trimethoprim-sulfamethoxazole)- and pentamidine-treated patients were similar, although the treatment cost and pharmacy cost were statistically different in favour of cotrimoxazole. Overall, cotrimoxazole is an inexpensive treatment option. However, the high incidence of adverse events attributed to this agent often necessitates a change to a more costly therapy.","Pharmacoeconomics, 10(1): 72-78","USA",1996,"HIV","Trimethoprim-sulfamethoxazole,Pentamidine",null,"Unknown","Cross-Sectional,Mortality,Cost and Resource Use","Retrospective Observational","USA","Unknown","HIV","Trimethoprim-sulfamethoxazole,Pentamidine","Cross-Sectional,Mortality,Cost and Resource Use","Retrospective Observational",null,"1995:1999"]
[47,"Novak, R. M., et al. (2012). \"Immune reconstitution inflammatory syndrome: incidence and implications for mortality.\" Aids 26(6): 721-730.",null,"Novak, R. M., et al.","Immune reconstitution inflammatory syndrome: incidence and implications for mortality","OBJECTIVE: To describe incidence of immune reconstitution inflammatory syndrome (IRIS) and its association with mortality in a large multisite US HIV-infected cohort applying an objective, comprehensive definition. DESIGN: We studied 2,610 patients seen during 1996-2007 who initiated or resumed highly active combination antiretroviral therapy (cART) and, during the next 6 months, demonstrated a decline in plasma HIV-RNA viral load of at least 0.5 log(10) copies/ml or an increase of at least 50% in CD4 cell count per microliter. We defined IRIS as the diagnosis of a type B or C condition [as per the Centers for Disease Control and Prevention (CDC) 1993 AIDS case definition] or any new mucocutaneous disorder during this same 6-month period. METHODS: We assessed the incidence of IRIS and evaluated risk factors for IRIS using conditional logistic regression and for all-cause mortality using proportional hazards models. RESULTS: We identified 370 cases of IRIS (in 276 patients). Median and nadir CD4 cell counts at cART initiation were 90 and 43 cells/mul, respectively; median viral load was 2.7 log(10) copies/ml. The most common IRIS-defining diagnoses were candidiasis (all forms), cytomegalovirus infection, disseminated Mycobacterium avium intracellulare, Pneumocystis pneumonia, varicella zoster, Kaposi's sarcoma and non-Hodgkin lymphoma. Only one case of Mycobacterium tuberculosis was observed. IRIS was independently associated with CD4 cell count less than 50 cells/mul vs. at least 200 cells/mul [odds ratio (OR) 5.0] and a viral load of at least 5.0 log(10) copies vs. less than 4.0 log(10) copies (OR 2.3). IRIS with a type B-defining or type C-defining diagnosis approximately doubled the risk for all-cause mortality. CONCLUSION: In this large US-based HIV-infected cohort, IRIS occurred in 10.6% of patients who responded to effective ART and contributed to increased mortality.","Aids, 26(6): 721-730","USA",2012,"HIV",null,null,"Unknown","Mortality,Cross-Sectional","Retrospective Observational","USA","Unknown","HIV",null,"Mortality,Cross-Sectional","Retrospective Observational",null,"2010:2014"]
[48,"Okafor, P. N., et al. (2015). \"Cost-effectiveness of Prophylaxis Against Pneumocystis jiroveci Pneumonia in Patients with Crohn's Disease.\" Dig Dis Sci 60(12): 3743-3755.",null,"Okafor, P. N., et al.","Cost-effectiveness of Prophylaxis Against Pneumocystis jiroveci Pneumonia in Patients with Crohn's Disease","BACKGROUND: Emerging evidence suggests that Pneumocystis jiroveci pneumonia is occurring more frequently in Crohn's disease patients on immunosuppressive medications, especially corticosteroids. Considering its excess mortality and the efficacy of chemoprophylaxis in reducing P. jiroveci pneumonia in acquired immunodeficiency syndrome, there is debate without consensus on the need for chemoprophylaxis in Crohn's disease patients on corticosteroids. AIMS: We sought to address this debate using insights from simulation modeling. METHODS: We used a Markov microsimulation model to simulate the natural history of Crohn's disease in 1 million virtual patients receiving appropriate care and who faced P. jiroveci pneumonia risks that varied with corticosteroid use. We examined several chemoprophylaxis strategies and compared their population-level economic and clinical impact using various indices including costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios. We also performed several nested probabilistic sensitivity analyses to estimate the health and economic impact of chemoprophylaxis in patients on triple immunosuppressive therapy. RESULTS: At the current PJP incidence, no PJP chemoprophylaxis was the preferred strategy from a population perspective. Considered chemoprophylactic strategies led to higher average costs and fewer P. jiroveci pneumonia cases. However, they also led to lower average quality-adjusted life expectancy and were thus dominated. Nevertheless, these alternative strategies became preferred with progressively higher risks of P. jiroveci pneumonia. Our results also suggest that PJP chemoprophylaxis may be cost-effective in patients on triple immunosuppressive therapy. CONCLUSION: Our findings support a case-by-case consideration of P. jiroveci pneumonia chemoprophylaxis in Crohn's disease patients receiving corticosteroids.","Dig Dis Sci, 60(12): 3743-3755","USA",2015,"Crohn's Disease","Prophylaxis",null,"Unknown","Economic Model,Mortality","Observational","USA","Unknown","Crohn's Disease","Prophylaxis","Economic Model,Mortality","Observational",null,"2015:2018"]
[49,"Parada, J. P., et al. (2003). \"Relationship between health insurance and medical care for patients hospitalized with human immunodeficiency virus-related Pneumocystis carinii pneumonia, 1995-1997: Medicaid, bronchoscopy, and survival.\" Clin Infect Dis 37(11): 1549-1555.",null,"Parada, J. P., et al.","Relationship between health insurance and medical care for patients hospitalized with human immunodeficiency virus-related Pneumocystis carinii pneumonia, 1995-1997: Medicaid, bronchoscopy, and survival","In the late 1980s, Medicaid-insured human immunodeficiency virus (HIV)-infected patients with Pneumocystis carinii pneumonia (PCP) were 40% less likely to undergo diagnostic bronchoscopy and 75% more likely to die than were privately insured patients, whereas rates of use of other, less resource-intensive aspects of PCP care were similar. We reviewed 1395 medical records at 59 hospitals in 6 cities for the period 1995-1997 to examine the impact of insurance status on PCP-related care. Medicaid patients were only one-half as likely to undergo diagnostic bronchoscopy as were privately insured patients, yet we found no evidence that mortality was greater among patients who received empirical treatment. The bronchoscopy rates were primarily related to patients' personal insurance status. A weaker hospital-level effect was seen that was related to hospitals' Medicaid/private insurance case mix ratios. The situation has evolved from one in which Medicaid coverage was associated with underuse of bronchoscopy and poorer survival among empirically treated persons with HIV-related PCP to one in which empirical therapy is effective in treating this disease and expensive diagnostic procedures may be overused for privately insured patients.","Clin Infect Dis, 37(11): 1549-1555","USA",2003,"HIV",null,null,"Unknown","Cross-Sectional,Mortality","Retrospective Observational","USA","Unknown","HIV",null,"Cross-Sectional,Mortality","Retrospective Observational",null,"2000:2004"]
[50,"Rizzardi, G. P., et al. (1996). \"Risks and benefits of aerosolized pentamidine and cotrimoxazole in primary prophylaxis of Pneumocystis carinii pneumonia in HIV-1-infected patients: a two-year Italian multicentric randomized controlled trial. The Italian PCP Study Group.\" J Infect 32(2): 123-131.",null,"Rizzardi, G. P., et al.","Risks and benefits of aerosolized pentamidine and cotrimoxazole in primary prophylaxis of Pneumocystis carinii pneumonia in HIV-1-infected patients: a two-year Italian multicentric randomized controlled trial. The Italian PCP Study Group","We randomized 220 HIV-1-infected subjects to receive aerosolized pentamidine (300 mg/4 weeks) or orally trimethoprim-sulfamethoxazole (320-1600 mg/day) for primary prophylaxis of Pneumocystis carinii pneumonia (PCP), and evaluated PCP and toxoplasmic encephalitis (TE) occurrence and survival. Patients developing toxicity switched to the other regimen. Analysis was on intention-to-treat. At 1 year of study, we observed in the pentamidine group a non-significant excess of PCP (4 vs. 1) and TE (7 vs. 3), and a significant increased death rate (15 vs. 2). After 2 years, no significant differences were observed: adjusted RR estimates for pentamidine vs. cotrimoxazole were 1.20 (95% CI, 0.33-4.37) for PCP (6 cases vs. 5), 1.23 (95% CI, 0.46-3.29) for TE (10 vs. 8) and 1.52 (95% CI, 0.83-2.79) for death (30 vs. 18). Crossovers were more frequent in the cotrimoxazole group (41 vs. 4, P < 0.001). Aerosolized pentamidine and cotrimoxazole were equally effective in preventing PCP, and no major differences were observed in TE occurrence and survival after 2 years follow-up.","J Infect, 32(2): 123-131","Italy",1996,"HIV","Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT","Italy","Unknown","HIV","Pentamidine,Trimethoprim-sulfamethoxazole","Mortality","RCT",null,"1995:1999"]
[51,"Robert-Gangneux, F., et al. (2014). \"Diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients by real-time PCR: a 4-year prospective study.\" J Clin Microbiol 52(9): 3370-3376.",null,"Robert-Gangneux, F., et al.","Diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients by real-time PCR: a 4-year prospective study","Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection in immunocompromised patients. Quantitative real-time PCR (qPCR) is more sensitive than microscopic examination for the detection of P. jirovecii but also detects colonized patients. Hence, its positive predictive value (PPV) needs evaluation. In this 4-year prospective observational study, all immunocompromised patients with acute respiratory symptoms who were investigated for PCP were included, totaling 659 patients (814 bronchoalveolar lavage fluid samples). Patients with negative microscopy but positive qPCR were classified through medical chart review as having retained PCP, possible PCP, or colonization, and their clinical outcomes were compared to those of patients with microscopically proven PCP. Overall, 119 patients were included for analysis, of whom 35, 41, and 43 were classified as having retained PCP, possible PCP, and colonization, respectively. The 35 patients with retained PCP had clinical findings similar to those with microscopically proven PCP but lower fungal loads (P < 0.001) and were mainly non-HIV-infected patients (P < 0.05). Although the mean amplification threshold was higher in colonized patients, it was not possible to determine a discriminant qPCR cutoff. The PPV of qPCR in patients with negative microscopy were 29.4% and 63.8% when considering retained PCP and retained plus possible PCP, respectively. Patients with possible PCP had a higher mortality rate than patients with retained PCP or colonization (63% versus 3% and 16%, respectively); patients who died had not received co-trimoxazole. In conclusion, qPCR is a useful tool to diagnose PCP in non-HIV patients, and treatment might be better targeted through a multicomponent algorithm including both clinical/radiological parameters and qPCR results.","J Clin Microbiol, 52(9): 3370-3376","France",2014,"HIV",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort","France","Unknown","HIV",null,"Mortality,Cross-Sectional","Prospective Cohort",null,"2010:2014"]
[52,"Rossi, M. R., et al. (1987). \"Prospective randomized comparison of two prophylactic regimens with trimethoprim-sulfamethoxazole in leukemic children: a two year study.\" Eur J Cancer Clin Oncol 23(11): 1679-1682.",null,"Rossi, M. R., et al.","Prospective randomized comparison of two prophylactic regimens with trimethoprim-sulfamethoxazole in leukemic children: a two year study","Between 1 July 1984 and 30 June 1986 all children treated for acute hematologic malignancy at our center were randomized to receive continuous (group A) or intermittent (3 days/week, group B) prophylaxis with trimethoprim-sulfamethoxazole (5-25 mg/kg/day/p.o.) against interstitial pneumonia with the aim of investigating if an intermittent regimen is as effective as and less toxic than a continuous regimen. The number of severe infections (group A, 17; group B, 21) and side-effects (group A, 30; group B, 34) was similar in the two groups, and compliance was also similar. We conclude therefore that neither regimen offers advantages over the other and the decision which to use should be based on cost (where regimen B has the advantage) and the children's and parents' preferences and compliance.","Eur J Cancer Clin Oncol, 23(11): 1679-1682","Italy",1987,"Not Specified","Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT","Italy","Unknown","Not Specified","Trimethoprim-sulfamethoxazole","Mortality","RCT",null,"1960:1989"]
[53,"Roux, A., et al. (2014). \"Pneumocystis jirovecii pneumonia in patients with or without AIDS, France.\" Emerg Infect Dis 20(9): 1490-1497.",null,"Roux, A., et al.","Pneumocystis jirovecii pneumonia in patients with or without AIDS, France","Pneumocystis jirovecii pneumonia (PCP) in patients without AIDS is increasingly common. We conducted a prospective cohort study of consecutive patients with proven PCP; of 544 patients, 223 (41%) had AIDS (AIDS patients) and 321 (59%) had other immunosuppressive disorders (non-AIDS patients). Fewer AIDS than non-AIDS patients required intensive care or ventilation, and the rate of hospital deaths--17.4% overall--was significantly lower for AIDS versus non-AIDS patients (4% vs. 27%; p<0.0001). Multivariable analysis showed the odds of hospital death increased with older age, receipt of allogeneic bone marrow transplant, immediate use of oxygen, need for mechanical ventilation, and longer time to treatment; HIV-positive status or receipt of a solid organ transplant decreased odds for death. PCP is more often fatal in non-AIDS patients, but time to diagnosis affects survival and is longer for non-AIDS patients. Clinicians must maintain a high index of suspicion for PCP in immunocompromised patients who do not have AIDS.","Emerg Infect Dis, 20(9): 1490-1497","France",2014,"AIDS,Immunocompromised",null,null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort","France","Unknown","AIDS,Immunocompromised",null,"Mortality,Cross-Sectional","Prospective Cohort",null,"2010:2014"]
[54,"Saah, A. J., et al. (1995). \"Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Multicenter AIDS Cohort Study.\" Jama 273(15): 1197-1202.",null,"Saah, A. J., et al.","Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Multicenter AIDS Cohort Study","OBJECTIVE: To identify clinical and epidemiological factors associated with failure of Pneumocystis carinii pneumonia (PCP) prophylaxis in those receiving primary and secondary prophylaxis. DESIGN: Longitudinal cohort study of participants infected with human immunodeficiency virus type 1 in the Multicenter AIDS Cohort Study who used PCP prophylaxis regimens after their T-helper lymphocyte counts had decreased to less than 0.200 x 10(9)/L (200/microL). MAIN OUTCOME MEASURE: Occurrence or recurrence of PCP. RESULTS: A total of 476 participants reported taking one or more of the following regimens: trimethoprim-sulfamethoxazole (TMP-SMX), dapsone, and/or aerosolized pentamidine--367 as primary prophylaxis and 109 as secondary prophylaxis after a previous episode of PCP. A total of 92 (20%) developed PCP despite prophylaxis. The mean failure rates per person-year of follow-up were 16.0% for those receiving primary prophylaxis and 12.1% for those receiving secondary prophylaxis (P = .19). Median times to death after initiation of primary or secondary prophylaxis were 2.0 and 1.2 years, respectively. The main predictor for failure of PCP prophylaxis was profound T-helper lymphocytopenia; 86% of failures occurred after T-helper cell counts decreased to less than 0.075 x 10(9)/L and 76% occurred after counts decreased to less than 0.050 x 10(9)/L. In multivariate time-dependent analysis, when compared with counts between 0.100 x 10(9)/L and 0.200 x 10(9)/L, the risk ratio for failure with counts less than 0.050 x 10(9)/L was 2.90 (P < .001). Once T-helper cell counts were considered, fever was the only other health status indicator that predicted subsequent PCP (ie, a time-dependent risk ratio of 2.22; P = .01). Use of TMP-SMX as the prophylaxis regimen was protective but did not eliminate failure (ie, a time-dependent risk ratio of 0.55; P = .03). CONCLUSIONS: These findings strongly support identifying improved methods of PCP prophylaxis once T-helper cell counts decrease to less than 0.075 x 10(9)/L or 0.100 x 10(9)/L. Given this severe degree of immunosuppression, an inherently more effective regimen against P carinii is required.","Jama, 273(15): 1197-1202","USA",1995,"AIDS","Trimethoprim-sulfamethoxazole,Dapsone,Pentamidine",null,"Unknown","Mortality,Cross-Sectional","Prospective Cohort","USA","Unknown","AIDS","Trimethoprim-sulfamethoxazole,Dapsone,Pentamidine","Mortality,Cross-Sectional","Prospective Cohort",null,"1995:1999"]
[55,"Samuel, C. M., et al. (2011). \"Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study.\" BMC Infect Dis 11: 329.",null,"Samuel, C. M., et al.","Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study","BACKGROUND: Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in HIV-infected African children. Microbiologic diagnosis relies predominantly on silver or immunofluorescent staining of a lower respiratory tract (LRT) specimens which are difficult to obtain in children. Diagnosis on upper respiratory tract (URT) specimens using PCR has been reported useful in adults, but data in children are limited. The main objectives of the study was (1) to compare the diagnostic yield of PCR with immunofluorescence (IF) and (2) to investigate the usefulness of upper compared to lower respiratory tract samples for diagnosing PCP in children. METHODS: Children hospitalised at an academic hospital with suspected PCP were prospectively enrolled. An upper respiratory sample (nasopharyngeal aspirate, NPA) and a lower respiratory sample (induced sputum, IS or bronchoalveolar lavage, BAL) were submitted for real-time PCR and direct IF for the detection of Pneumocystis jirovecii. A control group of children with viral lower respiratory tract infections were investigated with PCR for PCP. RESULTS: 202 children (median age 3.3 [inter-quartile range, IQR 2.2 - 4.6] months) were enrolled. The overall detection rate by PCR was higher than by IF [180/349 (52%) vs. 26/349 (7%) respectively; p < 0.0001]. PCR detected more infections compared to IF in lower respiratory tract samples [93/166 (56%) vs. 22/166 (13%); p < 0.0001] and in NPAs [87/183 (48%) vs. 4/183 (2%); p < 0.0001]. Detection rates by PCR on upper (87/183; 48%) compared with lower respiratory tract samples (93/166; 56%) were similar (OR, 0.71; 95% CI, 0.46 - 1.11). Only 2/30 (6.6%) controls were PCR positive. CONCLUSION: Real-time PCR is more sensitive than IF for the detection of P. jirovecii in children with PCP. NPA samples may be used for diagnostic purposes when PCR is utilised. Wider implementation of PCR on NPA samples is warranted for diagnosing PCP in children.","BMC Infect Dis, 11(329","South Africa",2011,"HIV",null,null,"Children","Diagnostic Research","Prospective Cohort","South Africa","Children","HIV",null,"Diagnostic Research","Prospective Cohort",null,"2010:2014","Bronchoalveolar lavage,Sputum Induction,Nasopharyngeal aspirate"]
[56,"Schneider, M. M., et al. (1992). \"A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group.\" N Engl J Med 327(26): 1836-1841.",null,"Schneider, M. M., et al.","A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group","BACKGROUND: Primary prophylaxis against Pneumocystis carinii pneumonia (PCP) is recommended for patients with human immunodeficiency virus (HIV) infection if their CD4 cell counts are below 200 per cubic millimeter (0.2 x 10(9) per liter). Either aerosolized pentamidine or trimethoprim-sulfamethoxazole (co-trimoxazole) is commonly prescribed for prophylaxis, but the relative efficacy and toxicity of these agents are unknown. METHODS: We conducted a multicenter trial involving 215 HIV-infected patients with no history of PCP but with CD4 cell counts below 200 per cubic millimeter. The patients were randomly assigned to one of three regimens: aerosolized pentamidine once a month, 480 mg of trimethoprim-sulfamethoxazole once a day (80 mg of trimethoprim and 400 mg of sulfamethoxazole), or 960 mg of trimethoprim-sulfamethoxazole once a day (160 mg and 800 mg, respectively). The cumulative incidence of PCP was estimated by Kaplan-Meier survival analysis. RESULTS: After a mean follow-up of 264 days, 6 of the 71 patients in the pentamidine group had a confirmed first episode of PCP (11 percent), whereas none of the 142 patients in the two trimethoprim-sulfamethoxazole groups had PCP (P = 0.002). However, adverse events that required discontinuation of the medication were much more frequent in the trimethoprim-sulfamethoxazole groups (17 and 18 patients) than in the pentamidine group (2 patients). The adverse reactions occurred significantly sooner in the group given 960 mg of trimethoprim-sulfamethoxazole than in the group given 480 mg (mean time, 16 vs. 57 days; P = 0.02). CONCLUSIONS: For patients with HIV infection, trimethoprim-sulfamethoxazole taken once a day is more effective as primary prophylaxis against PCP than aerosolized pentamidine administered once a month, although adverse drug reactions are more frequent with trimethoprim-sulfamethoxazole.","N Engl J Med, 327(26): 1836-1841","Netherlands",1992,"HIV","Pentamidine,Trimethoprim-sulfamethoxazole",null,"Unknown","Mortality","RCT","Netherlands","Unknown","HIV","Pentamidine,Trimethoprim-sulfamethoxazole","Mortality","RCT",null,"1990:1994"]
[57,"Schwarcz, S. K., et al. (1997). \"Prevention of Pneumocystis carinii pneumonia: who are we missing?\" Aids 11(10): 1263-1268.",null,"Schwarcz, S. K., et al.","Prevention of Pneumocystis carinii pneumonia: who are we missing?","OBJECTIVE: To obtain population-based information on the characteristics of persons who were not receiving chemoprophylaxis against Pneumocystis carinii pneumonia (PCP) by examining the use of primary and secondary PCP prophylaxis among San Francisco residents whose AIDS-defining opportunistic illness was PCP in 1993. DESIGN: Retrospective medical record review. SETTING: Medical charts were obtained from San Francisco hospitals and outpatient facilities at which AIDS patients received their initial AIDS diagnosis. PARTICIPANTS: San Francisco residents whose AIDS-defining opportunistic illness was PCP in 1993. MAIN OUTCOME MEASURES: Use of primary and secondary PCP prophylaxis. RESULTS: Of the 326 eligible patients, 35% received primary PCP prophylaxis. Non-whites were significantly less likely to have received primary PCP prophylaxis than white patients [22 versus 40%, respectively; odds ratio (OR), 0.49; 95% confidence intervals (CI), 0.28-0.87]. Uninsured individuals-were also less likely to have received primary PCP prophylaxis than those with insurance (18 versus 41%; OR, 0.35; 95% CI, 0.17-0.73). The sociodemographic characteristics of patients who did and did not receive secondary PCP prophylaxis did not differ significantly. The most frequently cited reasons for not receiving primary PCP prophylaxis were that patients were unaware of their infection with HIV or were not receiving regular medical care. CONCLUSIONS: Barriers to receipt of PCP prophylaxis exist and are resulting in cases of preventable disease and unnecessary medical costs. Interventions to increase counseling, testing, and referral to medical care for persons at high risk for HIV infection are needed.","Aids, 11(10): 1263-1268","USA",1997,"AIDS","Prophylaxis",null,"Unknown","Cost and Resource Use,Mortality,Cross-Sectional","Retrospective Observational","USA","Unknown","AIDS","Prophylaxis","Cost and Resource Use,Mortality,Cross-Sectional","Retrospective Observational",null,"1995:1999"]
[58,"Strenge, K. S., et al. (2015). \"Utility of reflexive gomori methenamine silver and Acid-fast bacillus staining on bronchoalveolar lavage specimens.\" Lab Med 46(1): 4-7.",null,"Strenge, K. S., et al.","Utility of reflexive gomori methenamine silver and Acid-fast bacillus staining on bronchoalveolar lavage specimens","OBJECTIVE: Reflexive testing of bronchoalveolar lavage (BAL) specimens with Gomori methenamine silver (GMS) and acid-fast bacillus (AFB) stains is not routinely performed by most institutions. Instead, these stains are usually ordered to evaluate for the presence of fungal elements and/or acid-fast organisms if initial histopathologic assessment suggests the presence of these pathogens. Our institution, however, performs these stains on all BAL specimens. Thus, we sought to determine whether this practice was cost effective, considering the turnaround time and diagnostic efficacy of these tests. METHODS: We retrospectively reviewed 488 BAL specimens performed at two military healthcare institutions over a 2-year period and performed a cost analysis with review of the impact on turnaround time. RESULTS: Of the 488 cases, we identified only 3 (~0.6%) with infections by acid-fast or fungal organisms, at an estimated total cost of $12,151.20 and an average delay of 3.0 to 3.5 hours for slide preparation. CONCLUSION: Our results suggest that in a largely young and healthy population such as ours, it may be more feasible to perform these stains on BAL specimens on a case-by-case basis rather than automatically on every specimen, to control costs and enhance productivity.","Lab Med, 46(1): 4-7","USA",2015,"Healthy",null,null,"Adults","Diagnostic Research,Cost and Resource Use","Retrospective Observational","USA","Adults","Healthy",null,"Diagnostic Research,Cost and Resource Use","Retrospective Observational",null,"2015:2018","Bronchoalveolar lavage"]
[59,"Torres, R. A., et al. (1993). \"Randomized trial of dapsone and aerosolized pentamidine for the prophylaxis of Pneumocystis carinii pneumonia and toxoplasmic encephalitis.\" Am J Med 95(6): 573-583.",null,"Torres, R. A., et al.","Randomized trial of dapsone and aerosolized pentamidine for the prophylaxis of Pneumocystis carinii pneumonia and toxoplasmic encephalitis","PURPOSE: Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis are the most frequent pulmonary and central nervous system opportunistic infections associated with human immunodeficiency virus (HIV) infection. We designed a prospective study to compare the effects of aerosolized pentamidine and dapsone in the prophylaxis of these infections in HIV-infected persons with CD4+ lymphocyte counts less than 250/mm3. PATIENTS AND METHODS: Two hundred seventy-eight patients seropositive for HIV who had acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex were randomly assigned to receive intermittent dapsone (100 mg twice weekly) or aerosolized pentamidine (100 mg every 2 weeks). The proportion of patients remaining free of PCP or toxoplasmosis was analyzed with the log-rank test as a function of time, as were the effects of zidovudine or prophylaxis on survival. RESULTS: Dapsone and aerosolized pentamidine demonstrated similar efficacy in the primary and secondary prophylaxis of PCP, with 15 (18%) failures among patients receiving dapsone compared to 15 (14%) among those receiving aerosolized pentamidine (p = 0.4), after a mean length of follow-up of 42 and 44 weeks, respectively. Dapsone was more effective in the primary prophylaxis of toxoplasmic encephalitis, with six toxoplasmic encephalitis events occurring among those receiving aerosolized pentamidine, compared to none among those taking dapsone (p = 0.01). Primary prophylaxis for PCP was more effective than secondary prophylaxis with either therapy. Zidovudine therapy did not prevent PCP yet prolonged the PCP-free interval for those in whom either prophylactic therapy failed. Kaplan-Meier estimates did not show a difference in survival between the patients receiving either therapy, yet zidovudine use was associated with improved survival, independent of race and risk factor (Cox proportional hazards model, p = 0.001). The 1-month survival for patients developing PCP despite prophylaxis was better with those in whom dapsone failed than it was for those in whom aerosolized pentamidine failed (p = 0.08). CONCLUSION: Dapsone is as effective as aerosolized pentamidine in preventing PCP and has the advantage of a lower cost, easier administration, and possibly an additional preventive effect against toxoplasmosis. Zidovudine prolongs the PCP-free interval for patients receiving prophylaxis, regardless of which prophylactic agent is used.","Am J Med, 95(6): 573-583","USA",1993,"AIDS","Dapsone,Pentamidine",null,"Unknown","Mortality","Prospective Cohort","USA","Unknown","AIDS","Dapsone,Pentamidine","Mortality","Prospective Cohort",null,"1990:1994"]
[60,"Wachter, R. M., et al. (1995). \"Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure.\" Jama 273(3): 230-235.",null,"Wachter, R. M., et al.","Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure","OBJECTIVE: To determine the costs and outcomes associated with intensive care unit (ICU) admission for patients with acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP), and severe respiratory failure. DESIGN: Survival and cost-effectiveness analysis. SETTING: A large municipal teaching hospital serving an indigent population. PATIENTS: Consecutive patients intubated and mechanically ventilated for AIDS, PCP, and respiratory failure from 1981 through 1991 (n = 113). The cohort was separated into three groups for analysis: patients admitted to the ICU in 1981 through 1985 (era I, n = 43), those admitted in 1986 through 1988 (era II, n = 33), and those admitted in 1989 through 1991 (era III, n = 37). MAIN OUTCOME MEASURES: Hospital charges and survival time; cost per year of life saved, using a zero-cost, zero-life assumption. RESULTS: Twenty-eight (25%) of the 113 patients mechanically ventilated for PCP and respiratory failure survived to hospital discharge: six (14%) of 43 in era I, 13 (39%) of 33 in era II, and nine (24%) of 37 in era III (P = .04). Post-ICU admission charges averaged $57,874 for the entire cohort, remaining relatively stable across the three eras. Cost of care for survivors was significantly more expensive than for those dying before discharge. The cost of ICU admission and subsequent hospitalization averaged $174,781 per year of life saved; $305,795 in era I, $94,528 in era II, and $215,233 in era III. Improved survival rates and shorter lengths of ICU stay led to the improved cost-effectiveness in era II, while the opposite trends resulted in worsening cost-effectiveness in recent years. The strongest predictors of hospital mortality in era III were low CD4 cell counts on hospital admission and the development of pneumothorax during mechanical ventilation. CONCLUSIONS: The cost-effectiveness of intensive care for patients with PCP and severe respiratory failure improved during the first 8 years of the AIDS epidemic but fell in recent years such that it is now below that of many accepted medical interventions.","Jama, 273(3): 230-235","USA",1995,"AIDS,Respiratory failure",null,null,"Unknown","Cost and Resource Use,Mortality","Retrospective Observational","USA","Unknown","AIDS,Respiratory failure",null,"Cost and Resource Use,Mortality","Retrospective Observational",null,"1995:1999"]
[61,"Wasserman, S., et al. (2013). \"Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: protocol for a systematic review.\" Syst Rev 2: 112.",null,"Wasserman, S., et al.","Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: protocol for a systematic review","BACKGROUND: Reports from Africa have suggested that pneumocystis pneumonia (PCP) is a less important cause of morbidity than in the developed world. However, more recent studies have shown high seroprevalence rates of P. jirovecii in healthy individuals with HIV as well as high rates of clinical disease in African children. This suggests that PCP may be more common in Africa than was previously recognised. Understanding the contribution of PCP to disease in HIV-infected individuals in sub-Saharan Africa (SSA) has important implications for diagnosis, management and resource allocation. We therefore propose to conduct a systematic review and meta-analysis in order to investigate the burden of PCP in this population. METHODS AND DESIGN: We plan to search electronic databases and reference lists of relevant articles published from 1995 to May 2013 using broad terms for pneumocystis, HIV/AIDS and sub-Saharan Africa. Studies will be included if they provide clear diagnostic criteria for PCP and well-defined study populations or mortality data (denominator). A novel quality score assessment tool has been developed to ensure fidelity to inclusion criteria, minimise risk of selection bias between reviewers and to assess quality of outcome ascertainment. This will be applied to eligible full-text articles. We will extract data using a standardised form and perform descriptive and quantitative analysis to assess PCP prevalence, mortality and case fatality, as well as the quality of included studies. This review protocol has been published in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42013005530. DISCUSSION: Our planned review will contribute to the diagnosis and management of community-acquired pneumonia in HIV-infected individuals in SSA by systematically assessing the burden of PCP in this population. We also describe a novel quality assessment tool that may be applied to other prevalence reviews.","Syst Rev, 2(112","South Africa",2013,"HIV,AIDS",null,null,"Children","Mortality,Cross-Sectional","Systematic Review","South Africa","Children","HIV,AIDS",null,"Mortality,Cross-Sectional","Systematic Review",null,"2010:2014"]
[62,"Wehner, J. H., et al. (1994). \"Controlled utilization of induced sputum analysis in the diagnosis of Pneumocystis carinii pneumonia.\" Chest 105(6): 1770-1774.",null,"Wehner, J. H., et al.","Controlled utilization of induced sputum analysis in the diagnosis of Pneumocystis carinii pneumonia","We investigated the outcome and potential cost savings of a system designed to limit physician access to induced sputum analysis (ISA) for the diagnosis of Pneumocystis carinii pneumonia (PCP). Four respiratory medicine physicians screened all requests for ISA to determine the pretest likelihood of PCP. Twenty-two of 102 requests for ISA over a 1-year period were denied due to a low clinical suspicion for PCP. Seven individuals had a definitive alternative diagnosis confirmed and the remaining 15 were empirically treated for a presumptive diagnosis. All individuals were followed for at least 60 days or until death. None of the 22 individuals developed PCP during the follow-up period. We estimate that this approach saved $27,474, avoided exposure of health care workers to Mycobacterium tuberculosis, and was educational for the referring physicians.","Chest, 105(6): 1770-1774","USA",1994,"Not Specified",null,null,"Unknown","Diagnostic Research","Retrospective Observational","USA","Unknown","Not Specified",null,"Diagnostic Research","Retrospective Observational",null,"1990:1994","Sputum Induction"]
[63,"Weverling, G. J., et al. (1999). \"Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection. EuroSIDA Study Group.\" Lancet 353(9161): 1293-1298.",null,"Weverling, G. J., et al.","Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection. EuroSIDA Study Group","BACKGROUND: Highly active antiretroviral therapy (HAART) has improved rates of CD4-lymphocyte recovery and decreased the incidence of HIV-1-related morbidity and mortality. We assessed whether prophylaxis against Pneumocystis carinii pneumonia (PCP) can be safely discontinued after HAART is started. METHODS: We investigated 7333 HIV-1-infected patients already enrolled in EuroSIDA, a continuing prospective observational cohort study in 52 centres across Europe and Israel. We did a person-years analysis of the rate of discontinuation of PCP prophylaxis and of the incidence of PCP after the introduction of HAART into clinical practice from July, 1996. FINDINGS: The rate of discontinuation of primary and secondary PCP prophylaxis increased up to 21.9 discontinuations per 100 person-years of follow-up after March, 1998. 378 patients discontinued primary (319) or secondary (59) prophylaxis a median of 10 months after starting HAART. At discontinuation for primary and secondary prophylaxis, respectively, the median CD4-lymphocyte counts were 274 cells/microL and 270 cells/microL, the median plasma HIV-1 RNA load 500 copies/mL, and the median lowest recorded CD4-lymphocyte counts 123 cells/microL and 60 cells/microL. During 247 person-years of follow-up, no patient developed PCP (incidence density 0 [95% CI 0-1.5]). INTERPRETATION: The risk of PCP after stopping primary prophylaxis, especially in patients on HAART with a rise in CD4-lymphocyte count to more than 200 cells/microL, is sufficiently low to warrant discontinuation of primary PCP prophylaxis. Longer follow-up is needed to confirm a similarly low risk for stopping secondary PCP prophylaxis.","Lancet, 353(9161): 1293-1298","Netherlands",1999,"HIV","Antiretroviral therapy",null,"Unknown","Mortality","Prospective Cohort","Netherlands","Unknown","HIV","Antiretroviral therapy","Mortality","Prospective Cohort",null,"1995:1999"]
[64,"Wynia, M. K., et al. (1998). \"Analysis of life-long strategies to prevent Pneumocystis carinii pneumonia in patients with variable HIV progression rates.\" Aids 12(11): 1317-1325.",null,"Wynia, M. K., et al.","Analysis of life-long strategies to prevent Pneumocystis carinii pneumonia in patients with variable HIV progression rates","OBJECTIVE: To compare strategies for life-long prophylaxis of Pneumocystis carinii pneumonia (PCP) in a group of AIDS patients with a wide range of disease progression rates. DESIGN: Markov decision models. METHODS: Prophylaxis strategies using high and low doses of trimethoprim-sulfamethoxazole (TS), dapsone, and/or aerosolized pentamidine in sequence, were compared. Efficacy and toxicity rates for prophylaxis regimens were taken from a meta-analysis of pertinent randomized controlled trials. Outcomes measured included lifetime episodes of PCP and drug toxicity per 100 patients treated, average life expectancy, and cost. RESULTS: For patients with an expected survival of 3 years after commencement of prophylaxis, the use of standard or low dose TS as the first choice agent was comparable, and both were superior to the other strategies for preventing PCP (between nine and 26 fewer episodes of PCP per 100 patients treated) though they were more toxic (11-44 more episodes of toxicity per 100 patients treated). Life expectancy was similar for all of the treatment strategies. With slower rates of disease progression (expected survival > 3.8 years), as seen with current antiretroviral regimens, the use of low dose TS as the first choice agent dominated the use of standard dose TS; when the expected survival time was 7 years, initial use of low dose TS led to 2.8 fewer episodes of PCP per 100 patients treated, 32 fewer episodes of toxicity per 100 patients treated, and US$1381 per patient lower cost, compared with prophylaxis with standard dose TS. CONCLUSION: For patients with AIDS and expected survival > 3.8 years, low dose TS is better than standard dose TS as the first choice agent for preventing PCP. As patients with AIDS live longer, the routine use of low dose TS will be more than adequate for patients at risk for PCP.","Aids, 12(11): 1317-1325","USA",1998,"AIDS","Dapsone,Trimethoprim-sulfamethoxazole",null,"Unknown","Economic Model,Mortality","Retrospective Observational","USA","Unknown","AIDS","Dapsone,Trimethoprim-sulfamethoxazole","Economic Model,Mortality","Retrospective Observational",null,"1995:1999"]
[65,"Yeung, K. T., et al. (1996). \"The safety of i.v. pentamidine administered in an ambulatory setting.\" Chest 110(1): 136-140.",null,"Yeung, K. T., et al.","The safety of i.v. pentamidine administered in an ambulatory setting","I.v. pentamidine is well known to cause severe multiorgan adverse effects and is usually given to hospitalized patients under close monitoring. The primary purpose of this retrospective quality assurance study is to assess the safety of administering i.v. pentamidine in the medical daycare unit (MDCU) for outpatients. Thirty-five outpatients infected with the HIV made 306 visits to the MDCU from January 1991 to December 1993. They received i.v. pentamidine in a dosage of either 300 mg once a month for prophylaxis or 4 mg/kg/d 5 days a week for treatment of Pneumocystis carinii pneumonia (PCP). BP was monitored every 15 to 30 min over 3 to 4 h and clinical side effects were noted. CBC count, BUN, creatinine, amylase, and blood glucose values were taken twice a week. The records were reviewed retrospectively and analyzed for clinical and biochemical derangement. GI side effects occurred in 59 of 306 (19%) visits; 43 (73%) of the side effects were nausea. Routine normal saline solution boluses before and after pentamidine infusion prevented the drop in BP and actually significantly elevated BP after i.v. pentamidine. The most common biochemical derangement was elevated BUN level in eight patients and creatinine in nine patients, but they were mild and required no intervention. Significant neutropenia occurred in three, anemia in two, hyponatremia in two, hyperamylasemia in two, and hyperglycemia in two patients. No palpitation or irregular pulse was encountered. No death was associated with the administration of i.v. pentamidine. Three patients required hospital admission. Only one hospital admission was definitely related to adverse drug effects. In conclusion, the side effects of i.v. pentamidine are common but minor. We conclude that it is safe to administer i.v. pentamidine in carefully selected patients with appropriate monitoring in an ambulatory setting. This has a major health economic implication, because ambulatory i.v. pentamidine can result in significant cost savings and can also enhance quality of life. Further studies regarding the feasibility of home administration of i.v. pentamidine is warranted as even further cost savings and improvement in the quality of life of HIV-infected patients may be achieved.","Chest, 110(1): 136-140","Canada",1996,"HIV","Pentamidine",null,"Unknown","Mortality,Cross-Sectional","Retrospective Observational","Canada","Unknown","HIV","Pentamidine","Mortality,Cross-Sectional","Retrospective Observational",null,"1995:1999"]
[66,"Zarkin, G. A., et al. (1996). \"Estimating the cost effectiveness of atovaquone versus intravenous pentamidine in the treatment of mild-to-moderate Pneumocystis carinii pneumonia.\" Pharmacoeconomics 9(6): 525-534.",null,"Zarkin, G. A., et al.","Estimating the cost effectiveness of atovaquone versus intravenous pentamidine in the treatment of mild-to-moderate Pneumocystis carinii pneumonia","Pneumocystis carinii pneumonia (PCP) is the most common severe opportunistic infection, and one of the most costly, among people with AIDS. Over 50% of patients experience toxic effects of the major anti-PCP medications- cotrimoxazole (trimethoprim-sulfamethoxazole) and pentamidine. Recently, the US Food and Drug Administration approved a new oral drug therapy, atovaquone, as an alternative to pentamidine for the treatment of people with mild-to-moderate PCP who are intolerant of cotrimoxazole. We developed a decision tree model to estimate the costs and cost effectiveness of atovaquone therapy compared with intravenous pentamidine therapy for cotrimoxazole-intolerant patients with mild-to-moderate PCP. Clinical outcomes were based on data from a phase III trial comparing the 2 medications. Our economic outcomes were based on treatment algorithms derived from discharge data, published reports and the clinical judgement of the co-authors. We estimate the total expected cost of treating a patient for an episode of PCP with atovaquone to be $US3990 compared with $US6545 for pentamidine under our baseline scenario (1995 dollars). Our decision model also provides insight into the large cost-savings benefits of treating mild-to-moderate PCP on an outpatient basis.","Pharmacoeconomics, 9(6): 525-534","USA",1996,"AIDS","Atovaquone,Pentamidine",null,"Unknown","Economic Model","Retrospective Observational","USA","Unknown","AIDS","Atovaquone,Pentamidine","Economic Model","Retrospective Observational",null,"1995:1999"]

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[null,null,56,null,null,null,null,null,"Unallocated","Case Study",null,null,null,null,null,null,null,null,null,null,null,"New names","Existing names",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Low year =",{"$f":"MIN($CF$3:$CF$60)","v":1960},null,1960,false,true,1960,1989,{"$f":"IF(CF3<>\"\",_xlfn.CONCAT(CF3,\":\",CG3),\"\")","v":"1960:1989"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Locations"},"Argentina","Antiretroviral therapy","AIDS",null,"Adults","Cost and Resource Use","Case Study",null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Unallocated"}]
[null,"From",null,null,"To",null,null,null,null,"Case Study",null,null,null,null,null,null,null,null,null,"Biomarker",null,"Diagnostic Tool","Diagnostic Tool","Locations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OFFSET($BY$5,domainChoice,0)","v":"studymethodCategories"},"High year =",{"$f":"MAX(CG3:$CG$60)","v":2018},null,1961,false,null,1990,1994,{"$f":"IF(CF4<>\"\",_xlfn.CONCAT(CF4,\":\",CG4),\"\")","v":"1990:1994"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Interventions"},"Brazil","Atovaquone","Crohn's Disease",null,"Children","Cross-Sectional","Clinical Study",null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Case Study"}]
[null,{"$f":"IF(CF3=\"\",\"\",CF3)","v":1960},null,null,{"$f":"IF(CG3=\"\",\"\",CG3)","v":1989},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Bronchoalveolar lavage",null,"C2","C2","Interventions",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962,false,"Segment count",1995,1999,"1995:1999","Diseases","Canada","Bubble CPAP","Dermatomyositis",null,"Unknown","Diagnostic Research","Narrative Review",null,null,null,null,"Clinical Study"]
[null,{"$f":"IF(CF4=\"\",\"\",CF4)","v":1990},null,null,{"$f":"IF(CG4=\"\",\"\",CG4)","v":1994},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sputum Induction",null,"C3","C3","Diseases",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"locationCategories",null,null,null,1963,false,null,2000,2004,"2000:2004","PRO tools","Chile","Ciprofloxacin","HIV",null,"Veterans","Economic Model","Observational",null,null,null,null,"Narrative Review"]
[null,1995,null,null,1999,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Brush biopsy",null,"C4","C4","Sub-populations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"interventionCategories",null,null,null,1964,false,null,2005,2009,"2005:2009","subPopulations","Denmark","Dapsone","Healthy",null,null,"Epidemiology","Prospective Cohort",null,null,null,null,"Observational"]
[null,2000,null,null,2004,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nasopharyngeal aspirate",null,"C5","C5","PRO tools",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"diseaseCategories",null,null,null,1965,false,null,2010,2014,"2010:2014","Study types","Ethiopia","Exercise test","Immunocompromised",null,null,"Mortality","RCT",null,null,null,null,"Prospective Cohort"]
[null,2005,null,null,2009,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nucleic acid amplification",null,null,null,"Study types",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"protoolCategories",null,null,null,1966,false,null,2015,2018,"2015:2018","Study methodologies","Europe","Pentamidine","Not Specified",null,null,"Pathology","Retrospective Observational",null,null,null,null,"RCT"]
[null,2010,null,null,2014,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Respiratory rate",null,null,null,"Study methodologies",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"subpopulationCategories",null,null,null,1967,false,null,null,null,"",null,"France","Prophylaxis","Respiratory failure",null,null,null,"Systematic Review",null,null,null,null,"Retrospective Observational"]
[null,2015,null,null,2018,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Specimen Collection",null,null,null,"Location categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studytypeCategories",null,null,null,1968,false,null,null,null,"",null,"Honduras","Trimethoprim-sulfamethoxazole","TB",null,null,null,null,null,null,null,null,"Systematic Review"]
[null,{"$f":"IF(CF10=\"\",\"\",CF10)","v":""},null,null,{"$f":"IF(CG10=\"\",\"\",CG10)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Laboratory Procedure",null,null,null,"Intervention categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studymethodCategories",null,null,null,1969,false,null,null,null,"",null,"India","Trimetrexate","Wegner's granulomatosis",null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"X-ray",null,null,null,"Disease categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970,false,null,null,null,"",null,"Italy","Zidovudine",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Hemoglobin oxygen saturation",null,null,null,"Sub-populations categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1971,false,null,null,null,"",null,"Japan",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Exercise Sputum",null,null,null,"PRO tool categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,false,null,null,null,"",null,"Malawi",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,{"$f":"IF(CG14=\"\",\"\",CG14)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study type categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1973,false,null,null,null,"",null,"Mexico",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodology categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1974,false,null,null,null,"",{"$f":"COLUMN()","v":87},"Netherlands",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1975,false,null,null,null,"",null,"Portugal",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1976,false,null,null,null,"",null,"South Africa",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1977,false,null,null,null,"",null,"Spain",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1978,false,null,null,null,"",null,"Switzerland",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1979,false,null,null,null,"",null,"Tanzania",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1980,false,null,null,null,"",null,"UK",null,null,null,null,null,null,null,null,null,null,""]
[null,"",22,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1981,false,null,null,null,"",null,"USA",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1982,false,null,null,null,"",null,"Unknown",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1983,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1984,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1985,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1986,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1987,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1988,false,null,null,null,{"$f":"IF(CF31<>\"\",_xlfn.CONCAT(CF31,\":\",CG31),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1989,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1990,true,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1991,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1992,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1993,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1994,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1995,true,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
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