The effect of adjunctive corticosteroids for the treatment of Pneumocystis carinii pneumonia on mortality and subsequent complications.
OBJECTIVE
To assess the long-term safety of adjunctive corticosteroids in the treatment of Pneumocystis carinii pneumonia (PCP).


METHODS
Analysis of data from a large prospective observational database.


METHODS
HIV clinic at a large urban teaching hospital.


METHODS
One hundred seventy-four patients who developed PCP after being enrolled in the database.


RESULTS
Fifty-three patients (30%) received adjunctive corticosteroids and 121 (70%) did not. Survival did not differ between groups after adjusting for CD4 count (relative risk for adjunctive corticosteroids = 0.74, p = 0.13). There were no differences in the incidence of cytomegalovirus disease (adjunctive corticosteroids: 18.5 cases per 100 person-years vs no adjunctive corticosteroids: 15.7, p = 0.22), Mycobacterium avium complex (23.4 vs 27.0, p = 0.73), cryptococcal meningitis (1.8 vs 4.1, p = 0.58), toxoplasmosis (3.6 vs 11.0, p = 0.28), Kaposi's sarcoma (1.8 vs 2.2, p = 0.92), herpes simplex (27.1 vs 42.7, p = 0.66), herpes zoster (3.8 vs 6.9, p = 0.71), oropharyngeal candidiasis (18.9 vs 10.9, p = 0.09), or non-Hodgkin's lymphoma (3.5 vs 4.2, p = 0.92). Esophageal candidiasis was more common among adjunctive corticosteroid recipients (45.1 vs 26.6, p = 0.01). Results were similar for time to development of opportunistic conditions.


CONCLUSIONS
Adjunctive corticosteroids do not increase mortality or the risk of most common HIV-associated complications.
Gallant
J E
JE
Johns Hopkins University School of Medicine, Baltimore, MD 21287-6220, USA.
Chaisson
R E
RE
Moore
R D
RD
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000401:mortality; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000305:Adrenal Cortex Hormones