scholarly journals On the Treatment of Pneumocystis jirovecii Pneumonia: Current Practice Based on Outdated Evidence

2021 ◽  
Author(s):  
Emily G McDonald ◽  
Guillaume Butler-Laporte ◽  
Olivier Del Corpo ◽  
Jimmy M Hsu ◽  
Alexander Lawandi ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Evidence Base ◽  
Dose Finding ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Persons Living With Hiv ◽  
Common Opportunistic Infection ◽  
Old Men ◽  
Living With Hiv ◽  
Historical Practice

Abstract Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection causing more than 400,000 cases annually worldwide. While antiretroviral therapy has reduced the burden of PCP in persons living with HIV, an increasing proportion of cases occur in other immunocompromised populations. In this review we synthesize the available randomized controlled trial (RCT) evidence-base for PCP treatment. We identified 14 RCTs that were conducted 25-35 years ago, principally in 40-year-old men with HIV. Trimethoprim-sulfamethoxazole (TMP-SMX), at a dose of 15-20mg/kg/day, is the treatment of choice based on historical practice rather than on quality comparative dose finding studies. Treatment duration is similarly based on historical practice and is not evidence-based. Corticosteroids have a demonstrated role in hypoxemic patients with HIV but have yet to be studied in RCTs as an adjunctive therapy in non-HIV populations. The echinocandins are potential synergistic treatments in need of further investigation.

scholarly journals MON-367 Unusual Presentation of Hypercalcemia Preceding the Diagnosis of Methotrexate-Induced Pneumocystis Jirovecii Pneumonia from Treatment of Necrotizing Myopathy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Minhthao Nguyen ◽  
Afshan Mohiuddin
Keyword(s):  
Case Reports ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Necrotizing Myopathy ◽  
Negative Results ◽  
Common Opportunistic Infection ◽  
High Level ◽  
Extended Course ◽  
Work Up ◽  
A Company

Abstract Background: Pneumocystis Jirovecii infection is a common opportunistic infection often seen severely immunocompromised individuals, such as those with HIV/AIDs. This is an unusual case where the patient displayed persistent hypercalcemia, with an eventual diagnosis of PCP likely due to immunosuppression from methotrexate (MTX) therapy. Case: A 79 year old male was brought to the hospital for acute change in mental status and hypercalcemia (13.4mg/dl). The patient was acutely encephalopathic, oriented to self only; his baseline was a high level executive at a company. An extensive neurologic workup including CT, MRI, EEG, spinal fluid examination was negative with a persistent hypercalcemia. Additional workup showed no increase in bone turnover, suppressed PTH, non-elevated pPTHrP. He was found to have diffuse mild PET avidity of bilateral lungs on PET scan, with bronchoscopy for evaluation of potential granulomatous disease. PCR of the BAL fluid obtained during bronchoscopy was positive, and the patient was ultimately treated with an extended course of Atovaquone for Pneumocystis Jirovecii pneumonia (PCP). The patient was felt to have an immunosuppressed state secondary to being treated for a necrotizing myopathy with methotrexate. The patient’s mentation slowly but substantially improved with a combination of a prednisone taper and Atovaquone, with discontinuation of the MTX. The patient’s hypercalcemia improved with treatment of PCP. Conclusion: Although a cause of hypercalcemia secondary to primary hyperparathyroidism causing necrotizing myopathy is known in the literature, it is unusual to see the opposite, where few case reports have documented hypercalcemia due to immunosuppression from low-dose methotrexate treatment for necrotizing myopathy resulting in pulmonary pneumocystis and hypercalcemia. Additionally, MTX induced immunodeficiency is often associated with severe immunosuppression or lymphoproliferative disorders - however the patient had an extensive work up with negative results for malignancy

scholarly journals 2017 HIV Medicine Association of Infectious Diseases Society of America Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With Human Immunodeficiency Virus

2017 ◽  
Vol 65 (10) ◽  
pp. 1601-1606 ◽  
Author(s):  
R Douglas Bruce ◽  
Jessica Merlin ◽  
Paula J Lum ◽  
Ebtesam Ahmed ◽  
Carla Alexander ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Human Immunodeficiency Virus ◽  
Infectious Diseases ◽  
Evidence Base ◽  
Chronic Noncancer Pain ◽  
Persons Living With Hiv ◽  
Immunodeficiency Virus ◽  
Physician Judgment ◽  
Noncancer Pain ◽  
Living With Hiv

Abstract Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population. It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.

Non-linear resistance training reduces inflammatory biomarkers in persons living with HIV: A randomized controlled trial

2016 ◽  
Vol 16 (8) ◽  
pp. 1232-1239 ◽  
Author(s):  
Hugo Ribeiro Zanetti ◽  
Lucas Gonçalves da Cruz ◽  
Camilo Luís Monteiro Lourenço ◽  
Fernando de Freitas Neves ◽  
Mário Leon Silva-Vergara ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Resistance Training ◽  
Controlled Trial ◽  
Inflammatory Biomarkers ◽  
Randomized Controlled ◽  
Linear Resistance ◽  
Persons Living With Hiv ◽  
Non Linear ◽  
Living With Hiv
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