Consensus statement on the use of corticosteroids as adjunctive therapy for Pneumocystis pneumonia in the acquired immunodeficiency syndrome

Article Abstract:

Pneumocystis carinii (PC) pneumonia is the most common life-threatening infection associated with AIDS. Some clinicians have suggested that the anti-inflammatory effects of corticosteroids may reduce the severity of PC pneumonia, while others have expressed concern that the use of corticosteroids in patients who are already immunocompromized may make them more susceptible to infection and hasten the progression of Kaposi's sarcoma. Now, however, an expert panel from the National Institutes of Health and the University of California has reviewed the results of five published studies and has concluded that the use of corticosteroids is clearly justified in the treatment of some AIDS patients with PC pneumonia. For AIDS patients with mild PC pneumonia, there is no clear-cut benefit to corticosteroid treatment. However, for AIDS patients with moderate-to-severe PC pneumonia, corticosteroids, such as prednisone or methylprednisolone, provide significant benefit and should be included in the treatment regimen. The expert panel recommends that corticosteroid therapy be started at the same time that antibiotic therapy is initiated for the pneumonia. The panel cautions that none of the available studies included children under 13 years. Since the both the immune systems and progress of PC pneumonia are different in children, further research will be required to determine if corticosteroids might be beneficial in young patients with AIDS. In addition, it is not known if higher doses of corticosteroids would be effective in saving patients who are deteriorating at the standard doses evaluated in the recent studies. Precisely how Pneumocystis carinii damages lung tissue and the mechanism of protection afforded by corticosteroids are not fully understood. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects

---

A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome

Article Abstract:

Corticosteroids increase the susceptibility of AIDS patients to infection with Pneumocystis carinii (PC), and might therefore seem an odd choice as a treatment for patients with PC pneumonia. However, corticosteroids also reduce the effects of inflammation, and may therefore prevent some of the severe lung damage and death resulting from PC pneumonia. For this reason, a total of 225 patients with confirmed Pneumocystis carinii pneumonia and 26 presumed cases were treated with antibiotics and randomly assigned to receive either adjunctive corticosteroid treatment or placebo treatment. Patients were also stratified for severity of disease on the basis of measurements of the oxygenation of arterial blood. The results revealed that patients receiving corticosteroids had significantly reduced risks of respiratory failure and death. However, respiratory failure and death were sufficiently rare among the patients with mild PC pneumonia that the trend did not achieve statistical significance in this group. The findings indicate that corticosteroid treatment should be included as a part of the therapy of AIDS patients with moderate or severe Pneumocystis carinii pneumonia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality

---

Similar abstracts:

• Abstracts: Are corticosteroids beneficial as adjunctive therapy for pneumocystis pneumonia in AIDS? Pneumocystis pneumonia: from bench to clinic
• Abstracts: A preliminary evaluation of 566C80 for the treatment of pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome
• Abstracts: Pneumocystis carinii pneumonia: the steroid dilemma. Steroids for Pneumocystis carinii pneumonia and respiratory failure in the acquired immunodeficiency syndrome: a reassessment
• Abstracts: Acyclovir-resistant varicella zoster virus infection after chronic oral acyclovir therapy in patients with the acquired immunodeficiency syndrome (AIDS)
• Abstracts: Beta-interferon therapy in patients with poor-prognosis Kaposi sarcoma related to the acquired immunodeficiency syndrome (AIDS)

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.