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Acute
Respiratory Failure Following HAART Introduction in Patients Treated
for Pneumocystis carinii Pneumonia [Wislez M et al. Am
J Respir Crit Care Med 2001;164:847] The authors from France
report three cases of acute respiratory failure after introducing
HAART in patients recently treated for P. carinii pneumonia. The
three patients who had PCP were treated with standard therapy, including
adjunctive steroids, and improved. HAART was introduced 1-16 days
after the diagnosis of PCP, and prednisone was stopped on day 15.
There was a second episode of severe acute respiratory failure with
high fever and patchy infiltrates at 7-17 days after HAART; BAL
showed sparse P. carinii cysts. All three patients responded
to re-treatment.
Comment:
The authors ascribed the patients' relapses to the combined effect
of steroid withdrawal and immune reconstitution attributed to HAART.
They also explain that these three cases occurred at a time when
there were a total of 65 cases of PCP at their institution, but
the frequency with which a similar treatment strategy and virologic
response occurred is not clear. The implication of this study is
that the simultaneous introduction of HAART and steroid withdrawal
for PCP may be ill advised; nevertheless, this is an anecdotal response
that certainly deserves a more systematic review or a controlled
trial.
posted
11/9/2001
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