The role of person-to-person transmission in an epidemiologic study of Pneumocystis carinii pneumonia.

OBJECTIVE: Recent laboratory studies suggest that may be transmitted from person-to-person. Recent exposure to persons with pneumonia (PCP) among HIV-infected persons with and without PCP was assessed to evaluate the person-to-person transmission hypothesis.

DESIGN: A case-control study design was used.

METHODS: In Seattle and Los Angeles, a history of contact with persons with PCP was compared between HIV-infected patients with laboratory-confirmed PCP (n = 209) and HIV-infected patients with no history of PCP (n = 254).

RESULTS: No association was found between past exposures to persons with PCP and an increased odds for PCP [odds ratio (OR), 0.6; 95% confidence interval (CI), 0.3-1.1] in the total study group. In addition, no association was observed when the analysis was restricted to cases and controls who were not on adequate PCP prophylaxis in the previous 3 months (OR, 0.7; 95% CI, 0.3-1.5). Most cases in Los Angeles (95%) and Seattle (96%) were not receiving PCP prophylaxis in the 3 months prior to a PCP diagnosis. Many controls in Los Angeles (54%) and Seattle (47%) were also not on prophylaxis. In addition, 23% of the Seattle cases and 42% of the Los Angeles cases were unaware of their HIV infection at the time of their PCP diagnosis.

CONCLUSIONS: Although most participants were not on adequate prophylaxis, we found no evidence of person-to-person transmission of Pneumocystis carinii in a population with advanced HIV disease. The difficulty quantifying past exposures to persons with PCP is a limitation of this type of research.