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

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.)