A multicenter randomized double-blind placebo-controlled trial of adjunctive corticosteroids in the treatment of Pneumocystis carinii pneumonia complicating the acquired immune deficiency syndrome

Article Abstract:

Corticosteroids appear to be of little benefit when used in addition to standard antimicrobial therapy in the treatment of Pneumocystis carinii pneumonia (PCP) in AIDS patients. A total of 78 AIDS patients with PCP were randomly assigned to treatment with either a corticosteroid known as methylprednisolone or a placebo, in addition to standard PCP therapy. Those assigned to corticosteroid therapy (40 patients) received 80 milligrams of methylprednisolone daily for at least 10 days. There were no significant differences in measures of oxygen pressure while breathing room air or in alveolar-arterial oxygen gradient between the two groups. Four patients receiving corticosteroids and six patients receiving placebo died. However, patients receiving the corticosteroid experienced fewer side effects to antimicrobial treatment. During trimethoprim-sulfamethoxazole therapy, 20 of 33 patients treated with corticosteroids were able to complete 21 days of treatment. Of those who received placebo, only 11 of 31 were able to complete 21 days of treatment. Additionally, patients' body temperatures returned to normal an average of 1.3 days after beginning corticosteroid therapy compared to an average of 5.7 days after beginning placebo treatment.

Evaluation, Complications and side effects, Methylprednisolone

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Specific considerations for cost-effectiveness studies in AIDS

Article Abstract:

Cost-effective analyses of treatments for AIDS require special considerations and methods that may not be necessary in analyzing treatments for other diseases. In the treatment of AIDS, unlike the treatment of other diseases, direct costs are much smaller than the indirect costs due to lost productivity. Cost-effective analysis of treatment in the early, asymptomatic stages of HIV infection may differ from analysis of later treatment. Side effects of anti-HIV drugs can also lead to great expense that must be considered. Analysis of HIV treatment is further complicated by the extraordinarily high cost of treating a few, particularly ill patients. Subjective measures of benefits, such as survival at a certain quality of life, are complicated by tradeoffs between time and quality and by difficulties in averaging quality ratings. One way to deal with such complications is to measure time spent in particular disease conditions.

Analysis, Economic aspects, HIV infection, HIV infections, Medical care, Cost of, Health care costs, Cost (Economics), Costs (Economics)

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Reconsidering the use of adjunctive corticosteroids in Pneumocystis pneumonia?

Article Abstract:

The main benefit of using corticosteroids in addition to standard treatment for Pneumocystis carinii pneumonia (PCP) appears to be in the prevention of respiratory failure and death in patients with moderate-to-severe disease. A placebo-controlled study conducted in Toronto and published in 1995 appeared to cast doubt on the benefit of corticosteroids as adjunctive therapy in the treatment of PCP. However, on closer examination it seems that the data do not in fact contradict recommendations for the use of corticosteroids issued in 1990 by the National Institute of Allergy and Infectious Diseases/University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis carinii Pneumonia. Meta-analysis of five studies on the effectiveness of corticosteroids in PCP, including the Toronto study, actually appears to support the panel's recommendations.

Health aspects, Editorial

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