Are corticosteroids beneficial as adjunctive therapy for pneumocystis pneumonia in AIDS?

Article Abstract:

Patients suffering from human immunodeficiency virus (HIV) infection frequently develop, as a result of their impaired immune systems, 'opportunistic infections' with microorganisms that do not usually cause disease. Infection with a bacteria called pneumocystis carinii is a frequent complication of HIV infection; this causes pneumocystis pneumonia. A patient who has had a prior history of pneumocystis pneumonia, and is taking only the antiviral drug zidovudine, has a 60 percent chance of developing a recurrence of pneumocystis pneumonia. Even patients receiving the antiviral drugs pentamidine and zidovudine have a relapse rate as high as 20 percent. Despite drastic improvements in drug therapy and survival rates, the fatality rate of pneumocystis pneumonia is still 10 percent. Currently, the antibiotic combination of trimethoprim-sulfamethoxazole, and the antiviral agent pentamidine, are the best therapies to cure and prevent recurrent infection with pneumocystis carinii. Drug treatment of pneumocystis pneumonia in HIV-infected patients often leads to a lowering of the oxygen content of the lung, which may lead to respiratory distress and death. This cascade of events is thought to occur because of a drug-induced inflammation of lung tissue. Agents called corticosteroids that reduce inflammation, but also inhibit the immune system, may help decrease the inflammation produced by anti-pneumocystis carinii drugs. However, they may also suppress the immune system even further. Currently, there are conflicts in the literature regarding the adjunct use of corticosteroids in the management of pneumocystis pneumonia, but this may reflect differences among studies in experimental design. Well designed clinical trials to assess the efficacy of corticosteroids in this condition are clearly needed before the treatment strategy for pneumocystis pneumonia is changed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, editorial

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CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection

Article Abstract:

Opportunistic infections, which occur because of a patient's altered physiological state, are the major cause of life-threatening disease and death in patients infected with the human immunodeficiency virus (HIV). HIV infection depletes CD4 or helper T cells, a type of immune cell involved in increasing the production of antibodies, immune proteins that bind to and inactivate foreign particles. The depletion of CD4 cells results in a weakened immune system and increased risk of developing opportunistic infections. The number of CD4 cells has been shown to be a good indicator of the immune activity in HIV-infected patients, and have been used to predict whether an HIV-infected patients will develop AIDS (acquired immunodeficiency syndrome). The usefulness of CD4 counts in diagnosing pneumonia in 100 HIV-infected patients was assessed. CD4 counts were less than 200 cells per cubic millimeter before 46 of 49 cases of pneumocystis pneumonia, before all eight cases of cytomegalovirus pneumonia, all seven cases of Mycobacterium avium-intracellular infection, and 19 of 21 cases of infection with Cryptococcus neoformans. Thus, pneumocystis pneumonia, cytomegalovirus pneumonia, and lung infection by C. neoformans and M. avium-intracellular are not likely to occur in patients with CD4 counts greater than 200 to 250 cells per cubic millimeter, or a CD4 percent of circulating lymphocytes of 20 to 25 percent. Patients with CD4 counts less than 200 cells per cubic millimeter may benefit from prophylaxis against pneumocystis infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Diagnosis, Measurement, Lungs, Lung, T cells, Lymphocytes, Opportunistic infections

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Pneumocystis pneumonia: from bench to clinic

Article Abstract:

Pneumocystis carinii, an organism that causes pneumocystis pneumonia, is found almost exclusively in the lungs and occurs primarily in individuals who are immunocompromised, such as those infected with the human immunodeficiency virus (HIV), cancer patients and transplant recipients. This organism has received more attention in recent years as infections have become more frequent. The immunological basis for susceptibility to this infection is discussed, along with epidemiologic and diagnostic implications. Reports on recent metabolic studies are reviewed and implications for treatment and therapy alternatives are presented. Much progress in prevention, diagnosis and treatment has been made in the last decade. The increased number of P. carinii pneumonia cases that has accompanied the increase in HIV infections has created a greater need for prophylactic therapies. Recently methoprim-sulfamethoxazole or aerosol pentamidine have been used as preventative measures. New approaches to treatment have been helped by research in immunology, metabolism, and molecular biology, and doctors are hopeful that less toxic yet effective treatments will be available in the near future. However, there is a great deal about P. carinii that is still unknown and additional research is still needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Research, Immunological deficiency syndromes, Immunologic deficiency syndromes

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