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Treatment and prevention of Pneumocystis infection in HIV-infected patients

Author
Paul E Sax, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Pneumocystis jirovecii pneumonia (formerly called Pneumocystis carinii pneumonia or PCP) is the most common opportunistic respiratory infection in patients infected with AIDS. It typically occurs in HIV-infected patients with a CD4 count <200 cells/microL who are not receiving potent antiretroviral therapy or appropriate prophylaxis.

This topic will review the treatment and prevention of PCP in patients with HIV infection. Topic reviews on the clinical presentation and diagnosis of PCP in HIV-infected individuals and PCP in the non-HIV-infected host are discussed separately. (See "Clinical presentation and diagnosis of Pneumocystis pulmonary infection in HIV-infected patients" and "Epidemiology, clinical manifestations, and diagnosis of Pneumocystis pneumonia in non-HIV-infected patients" and "Treatment and prevention of Pneumocystis pneumonia in non-HIV-infected patients".)

TREATMENT

Antimicrobial therapy directed against P. jirovecii is the mainstay of treatment for Pneumocystis pneumonia (PCP). In addition, some patients will require adjunctive corticosteroids. Antiretroviral therapy (ART) should be initiated to restore cellular immunity. For those patients already receiving ART, we continue their ART regimen while they are being treated for PCP. (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient" and 'Timing of ART initiation' below.)

Empiric therapy for PCP should be initiated pending the results of the diagnostic evaluation if there is a high clinical suspicion for PCP (eg, CD4 count <200 cells/microL, hypoxemia, interstitial infiltrates). In certain situations, it is not possible to confirm the diagnosis, and patients are treated and monitored for clinical response (see 'Monitoring patients on treatment' below). A detailed discussion on the clinical manifestations and diagnosis of PCP is found elsewhere. (See "Clinical presentation and diagnosis of Pneumocystis pulmonary infection in HIV-infected patients".)

After patients complete their initial treatment regimen, antimicrobial therapy should be continued at lower doses to prevent recurrent infection (ie, secondary prophylaxis). This preventive therapy can be discontinued after immune recovery has been achieved for a prolonged period of time. (See 'Secondary prophylaxis' below.)

                                   

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Literature review current through: Jun 2015. | This topic last updated: Jun 24, 2015.
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