Abstract
BackgroundThe current guidelines recommend 21-day adjunctive corticosteroid therapy for HIV-1-infected pneumocystis pneumonia patients (HIV-PCP) with moderate-to-severe disease. Whether shorter adjunctive corticosteroid therapy is feasible in such patients is unknown.MethodsWe conducted a retrospective study to elucidate the proportion of patients with moderate and severe HIV-PCP who required adjunctive corticosteroid therapy for 21 days. The enrollment criteria included HIV-PCP that fulfilled the current criteria for 21-day corticosteroid therapy; PaO2 on room air of <70mmHg or A-aDO2 ≥35 mmHg.ResultsThe median duration of corticosteroid therapy in the 73 study patients was 13 days (IQR 9–21). Adjunctive corticosteroid therapy was effective and discontinued within 10 and 14 days in 30% and 60% of the patients, respectively. Only 9% of the patients with moderate HIV-PCP (n = 22, A-aDO2 35–45 mmHg) received steroids for >14 days, whereas 35% of the patients with severe HIV-PCP (n = 51, A-aDO2 ≥45 mmHg) required corticosteroid therapy for ≥21 days. Four (13%) of the severe cases died, whereas no patient with moderate disease died. Among patients with severe HIV-PCP, discontinuation of corticosteroid therapy within 14 days correlated significantly with higher baseline CD4 (p = 0.049).ConclusionShorter adjunctive corticosteroid therapy was clinically effective and adjunctive corticosteroid could be discontinued within 14 days in 60% of moderate-to-severe HIV-PCP and 90% of moderate cases.
Highlights
Shorter adjunctive corticosteroid therapy was clinically effective and adjunctive corticosteroid could be discontinued within 14 days in 60% of moderate-to-severe HIV-Pneumocystis pneumonia (PCP) and 90% of moderate cases
Combination antiretroviral therapy has substantially improved the prognosis of patients with HIV-1 infection, a large number of patients are still diagnosed with HIV-1 infection at a late stage, often with concurrent opportunistic infections [1]
The American CDC Guidelines recommend 21 days of adjunctive systemic corticosteroid therapy for moderate-to-severe PCP associated with HIV-1 infection [defined as PCP with room air alveolar-arterial O2 gradient (A-aDO2) 35 mmHg or partial pressure of atrial oxygen (PaO2)
Summary
Combination antiretroviral therapy (cART) has substantially improved the prognosis of patients with HIV-1 infection, a large number of patients are still diagnosed with HIV-1 infection at a late stage, often with concurrent opportunistic infections [1]. The American CDC Guidelines recommend 21 days of adjunctive systemic corticosteroid therapy for moderate-to-severe PCP associated with HIV-1 infection [defined as PCP with room air alveolar-arterial O2 gradient (A-aDO2) 35 mmHg or partial pressure of atrial oxygen (PaO2)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have