Treatment of Pneumocystis jirovecii pneumonia in HIV-infected patients: a review
Journal
Expert Review of Anti-Infective Therapy
Journal Volume
15
Journal Issue
9
Pages
873-892
Date Issued
2017
Author(s)
Abstract
Introduction: Pneumocystis pneumonia 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), Pneumocystis pneumonia 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 for Pneumocystis pneumonia in HIV-infected patients. Articles for this review were identified through searching PubMed. Search terms included: ‘Pneumocystis pneumonia’, ‘Pneumocystis jirovecii pneumonia’, ‘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 for Pneumocystis pneumonia 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 for Pneumocystis pneumonia is warranted. ? 2017 Informa UK Limited, trading as Taylor & Francis Group.
SDGs
Other Subjects
alkaline phosphatase; antiretrovirus agent; aspartate aminotransferase; atovaquone; caspofungin; clindamycin; corticosteroid; cotrimoxazole; dapsone; dihydropteroate synthase; echinocandin; pentamidine; primaquine; sulfanilamide; trimetrexate; anti human immunodeficiency virus agent; antiinfective agent; bacterial protein; cotrimoxazole; dihydropteroate synthase; acquired immune deficiency syndrome; diagnostic test; diarrhea; dihydropteroate synthase gene; disease severity; drug choice; drug efficacy; drug safety; drug treatment failure; dysglycemia; electrolyte disturbance; fever; gene mutation; headache; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; hyperglycemia; hyperkalemia; hypersensitivity; hypokalemia; hypotension; infection prevention; kidney disease; kidney injury; liver toxicity; maculopapular rash; megaloblastic anemia; mental disease; nausea; nephrotoxicity; neutropenia; nonhuman; Pneumocystis jiroveci; Pneumocystis pneumonia; primary prevention; Review; secondary prevention; side effect; thrombocytopenia; thrombophlebitis; torsade des pointes; vomiting; AIDS related complex; antibiotic resistance; CD4 lymphocyte count; drug effect; genetics; highly active antiretroviral therapy; Human immunodeficiency virus 1; immunocompromised patient; immunology; metabolism; microbiology; mutation; pathogenicity; Pneumocystis carinii; Pneumocystis pneumonia; treatment outcome; virology; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Bacterial Proteins; CD4 Lymphocyte Count; Dihydropteroate Synthase; Drug Resistance, Bacterial; HIV-1; Humans; Immunocompromised Host; Mutation; Pneumocystis carinii; Pneumonia, Pneumocystis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination
Publisher
Taylor and Francis Ltd
Type
review