Steroids do not enhance the risk of developing tuberculosis or other AIDS-related diseases in HIV-infected patients treated for Pneumocystis carinii pneumonia.

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Steroids do not enhance the risk of developing tuberculosis or other AIDS-related diseases in HIV-infected patients treated for Pneumocystis carinii pneumonia.

AIDS. 1995 Sep;9(9):1037-41. Unique Identifier : AIDSLINE MED/96085718
Martos A; Podzamczer D; Martinez-Lacasa J; Rufi G; Santin M; Gudiol F; Infectious Disease Service, Ciutat Sanitaria de Bellvitge,; University of Barcelona, Spain.

Abstract: OBJECTIVE: To evaluate the risk of developing tuberculosis or other AIDS-related diseases (ARD) in HIV-infected patients treated with corticosteroids as adjunctive therapy for Pneumocystis carinii pneumonia (PCP). DESIGN: Retrospective study. SETTING: Infectious Disease Service of a 1000-bed university teaching hospital in Barcelona, Spain. PATIENTS: HIV-infected patients diagnosed with PCP from 1985 to 1992. Patients were classified into two groups: steroid (group A) and non-steroid (group B) adjunctive therapy. Baseline characteristics, antibiotherapy, dose and duration of steroidal treatment were analysed. Endpoints were either the development of tuberculosis or other ARD or death. RESULTS: From the 129 patients included in this study 72 were in group A and 57 in group B. No differences between groups were observed in baseline characteristics or mean follow-up period (15 versus 14 months, respectively). The mean total dose of steroids was 420 mg (range, 160-1260 mg) methylprednisolone or its equivalent in dexamethasone, with a mean treatment duration of 12 days (range, 4-33 days). No differences were found in the occurrence of tuberculosis or other endpoints in the first 6 months of follow-up. In addition, the cumulative rate of developing tuberculosis was 7% in group A and 12% in group B at 12 months of follow-up, and 13 versus 12% at 24 months (P = 0.622, Mantel-Cox): 4 versus 4% at 12 months and 27 versus 24% at 24 months (P = 0.873) for non-tuberculosis mycobacterial infection, and 40 versus 42% at 12 months, and 88 versus 66% at 24 months (P = 0.330) for non-mycobacterial ARD. The cumulative survival rate was 79 versus 71% and 46 versus 34% at 12 and 24 months, respectively (P = 0.526). CONCLUSIONS: Our data suggest that the use of corticosteroids during PCP in HIV-infected patients at the doses and for the duration used in our patients did not enhance the risk of developing or relapsing tuberculosis or other ARD.

Keywords: Adrenal Cortex Hormones/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Adult AIDS-Related Opportunistic Infections/*DRUG THERAPY/IMMUNOLOGY/ MORTALITY Comparative Study Dexamethasone/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Drug Therapy, Combination Female Follow-Up Studies Human Male Methylprednisolone/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Middle Age Pentamidine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Pneumonia, Pneumocystis carinii/*DRUG THERAPY/IMMUNOLOGY/ MORTALITY Retrospective Studies Risk Factors Survival Rate Trimethoprim-Sulfamethoxazole Combination/ADMINISTRATION & DOSAGE/ ADVERSE EFFECTS Tuberculosis, Pulmonary/*IMMUNOLOGY/MORTALITY JOURNAL ARTICLE
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