Role of Adjunctive Corticosteroids Treatment in HIV Patients with Severe Pneumocystis Pneumonia; Experience from a Tertiary Care Hospital

Abstract

Background: Pneumocystis Jiroveci Pneumonia (PCP) remains a prevalent opportunistic infection in individuals with human immunodeficiency virus (HIV) infection. It is associated with a mortality rate of 10% to 20% during the initial infection, and this rate significantly escalates when mechanical ventilation is required. Earlier studies have suggested that individuals with HIV/AIDS who have PCP may benefit significantly from the combination of corticosteroid treatment with other antibiotic therapy. Objective: This study aimed to investigate the potential role of adjunctive corticosteroid therapy in the treatment of patients with Pneumocystis jiroveci pneumonia (PCP) and HIV. The primary goal of our study was to ascertain patient survival until their discharge from the hospital and to understand their experience with respiratory failure. Methodology: This placebo-controlled trial study was conducted at the Department of Medical Unit, Lady Reading Teaching Hospital, Peshawar. The study spanned six months following approval from the hospital's ethical board. The sampling technique employed was non-probability convenience-based sampling. The sample size was determined using Open Epi with a confidence level of 95%, a margin of error of 2%, and a population proportion of 0.916, resulting in an estimated sample size of 86 and in this study, a total of 90 study cases were enrolled. Objective: The primary objective of this study was to investigate the potential role of adjunctive corticosteroid treatment in HIV patients suffering from severe Pneumocystis pneumonia (PCP). Specifically, we aimed to assess whether corticosteroids could offer supplementary benefits in the management of severe PCP cases among individuals living with HIV. Results: A total of 90 HIV-positive cases were enrolled in this study of which 73 (81.2%) were male and 17 (18.8%) were female. The study cases were divided into two groups for study purposes. One group was treated with corticosteroids and the other one was a placebo group. All patients enrolled in this study also screened for baseline blood investigations and no significant differences were found in these investigations. Among the corticosteroids group, 35 (777.8%) patients survived until hospital discharge, as compared to the placebo group where 8 (17.8%) survived until hospital discharge (CI 0.08 - 0.77: P<0.001). Conclusions: Early adjunctive corticosteroid therapy represents a pivotal intervention for patients with AIDS suffering from severe Pneumocystis carinii pneumonia. This treatment not only enhances survival rates but also significantly reduces the incidence of respiratory failure. Keywords: Pneumocystis Jiroveci Pneumonia; HIV: Trials: Corticosteroids; Placebo; Peshawar