Pneumocystis carinii pneumonia (PCP) trends were examined in Houston/Harris County, Texas from 1988-2005. The incidence of PCP at AIDS diagnosis decreased significantly over this period, from over 60% in 1988 to 7.4% in 2005. Males were about 1.6 times more likely than females to be diagnosed with PCP. Although PCP diagnosis has decreased with increased access to healthcare and antiretroviral treatment, it remains a common AIDS-defining illness, especially in those not receiving treatment for HIV.

1. Pneumocystis carinii Pneumonia Trends at the time of AIDS diagnosis: During Early-phase, Mid-phase and Current-phase of AIDS in Houston Harris County 1988 - 2005 17 th Texas HIV/STD Conference Ukari Oku, MPH, HIV/STD Surveillance Program City of Houston Bureau of Epidemiology

2. Objective The purpose of this study is to examine the diagnosis of PCP trends in the early Phase (1988-93) to Mid-phase (1994-99) and Current Phase (2000-05) at the time AIDS diagnosis in Houston/Harris County, Texas

3. Background AIDS-defining illness and often fatal pulmonary disease caused by a yeast-like fungus Most common opportunistic infection in people with HIV Pneumocystis infection develops in the lungs, where inflammation occurs and fluid builds up. The fluid build up causes pneumonia Clinical signs: difficulty breathing, dry non-productive cough and fever Lab diagnosis: isolated from induced sputum, broncho-alveolar lavage or open lung biopsy

4. Methods PCP trends were calculated for three periods: from 1988-1993, 1994-1999, to 2000-2005 at the initial diagnosis of AIDS Trends and comparisons in the incidence of PCP were investigated using STATA version 11

5. Results

6. Statistics and Trends From January 1988 to December 2005, there were 20,816 HIV cases in Houston Harris County—of these, 5,275 (25%) were diagnosed with PCP Selected demographic characteristics of cases diagnosed with PCP

7. Statistics and Trends In the early-phase 1988-93 there was dramatic decrease in the number of PCP cases (from over 60% in 1988 to 23% in 1993). In the mid-phase 1994-99 there was a decrease in the number of PCP cases (from 24% in 1994 to 14% in 1999) although p- value for a linear trend was not significant. In the current-phase 2000-05 there was a further significant decrease in the number of PCP cases (from 14.5% in 2000 to 7.4 in 2005).

8. Statistics and Trends To re-cap, in the eighteen year period from 1988 – 2005 our finding show there was a significant decrease in the diagnosis of PCP On logistic regression analysis, males were 1.6 (1.47 – 1.79) times as likely than females to be diagnosed with PCP (dependent variable=PCP with positive dx coded as 1, independent variable=sex with males coded as 1 and females as 0, and covariates were age and race/ethnicity).

9. Limitations The number of reported cases of PCP may have been under reported for the period under study Based on the case definition for PCP, presumptive diagnosis were included in this analysis

10. Conclusions Although the trends in PCP events have decreased from 1988 to 2005, it remains the most common AIDS defining condition in AIDS patients and it is still common in people who do not know they are infected with HIV Studies have shown that access to health care was directly related to HAART treatment and PCP prophylaxis. The best way to prevent PCP is to keep your CD4 count above 200 This information is important in devising prevention strategies to further reduce the incidence of PCP among HIV-infected patients This analysis will assist in raising awareness concerning need for prophylaxis and treatment of HIV/AIDS of those patients in care

11. Acknowledgements James Gomez BS, Rehman Hafeez MD, MPH Staff of the HIV/STD Surveillance Program, HDHHS Bureau of Epidemiology This work was supported by cooperative agreements from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

12. Table 1. Characteristics of HIV+ persons infected with pneumocystis carinii pneumonia (PCP)

13. Fig. 1. Early phase incidence of pneumocystis carinii pneumonia at the time of AIDS diagnosis

14. Fig. 2. Mid-phase incidence of pneumocystis carinii pneumonia at the time of AIDS diagnosis Start of HARRT ERA

15. Fig. 3. Current-phase incidence of pneumocystis carinii pneumonia at the time of AIDS diagnosis

16. Fig. 6. Incidence of pneumocystis carinii pneumonia at the time of AIDS diagnosis by gender

17. Fig. 5. Incidence of pneumocystis carinii pneumonia 1988 - 2005 Pre-HARRT Post-HARRT Early-phase Mid-phase Current-phase