1. Treatment of Pneumocystis jirovecii pneumonia in HIV-infected patients: a review.
- Author
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Huang, Yu-Shan, Yang, Jen-Jia, Lee, Nan-Yao, Chen, Guan-Jhou, Ko, Wen-Chien, Sun, Hsin-Yun, and Hung, Chien-Ching
- Subjects
ANTIBIOTICS ,ANTI-HIV agents ,BACTERIAL protein metabolism ,BACTERIAL proteins ,DRUG resistance in microorganisms ,FUNGI ,HIV ,GENETIC mutation ,PNEUMOCYSTIS pneumonia ,TRANSFERASES ,AIDS-related opportunistic infections ,HIGHLY active antiretroviral therapy ,TREATMENT effectiveness ,CD4 lymphocyte count ,IMMUNOCOMPROMISED patients - Abstract
Introduction:Pneumocystispneumonia is a potentially life-threatening pulmonary infection that occurs in immunocompromised individuals and HIV-infected patients with a low CD4 cell count. Trimethoprim-sulfamethoxazole has been used as the first-line agent for treatment, but mutations within dihydropteroate synthase gene render potential resistance to sulfamide. Despite advances of combination antiretroviral therapy (cART),Pneumocystispneumonia continues to occur in HIV-infected patients with late presentation for cART or virological and immunological failure after receiving cART. Areas covered: This review summarizes the diagnosis and first-line and alternative treatment and prophylaxis forPneumocystispneumonia in HIV-infected patients. Articles for this review were identified through searching PubMed. Search terms included: ‘Pneumocystispneumonia’, ‘Pneumocystis jiroveciipneumonia’, ‘Pneumocystis carinii pneumonia’, ‘trimethoprim-sulfamethoxazole’, ‘primaquine’, ‘trimetrexate’, ‘dapsone’, ‘pentamidine’, ‘atovaquone’, ‘echinocandins’, ‘human immunodeficiency virus infection’, ‘acquired immunodeficiency syndrome’, ‘resistance to sulfamide’ and combinations of these terms. We limited the search to English language papers that were published between 1981 and March 2017. We screened all identified articles and cross-referenced studies from retrieved articles. Expert commentary: Trimethoprim-sulfamethoxazole will continue to be the first-line agent forPneumocystispneumonia given its cost, availability of both oral and parenteral formulations, and effectiveness or efficacy in both treatment and prophylaxis. Whether resistance due to mutations within dihydropteroate synthase gene compromises treatment effectiveness remains controversial. Continued search for effective alternatives with better safety profiles forPneumocystispneumonia is warranted. [ABSTRACT FROM PUBLISHER]
- Published
- 2017
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