HIV: treating Pneumocystis pneumonia (PCP).
BACKGROUND
Pneumocystis pneumonia (PCP) is a common AIDS-defining opportunistic illness in people with HIV infection, but its incidence has fallen with use of prophylactic treatment. Without treatment, PCP is likely to be fatal in people with AIDS, so placebo-controlled studies would be considered unethical.


METHODS
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of first-line antipneumocystis treatments for Pneumocystis pneumonia in people infected with HIV? What are the effects of adjuvant corticosteroids in people receiving first-line antipneumocystis treatments for Pneumocystis pneumonia in people infected with HIV? What are the effects of treatments for Pneumocystis pneumonia in people infected with HIV who have not responded to first-line antipneumocystis treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).


RESULTS
We found 22 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.


CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant corticosteroids, aerosolised or intravenous pentamidine, atovaquone, clindamycin-primaquone, treatment after failure of first-line treatment, trimethoprim-dapsone, and trimethoprim-sulfamethoxazole (TMP-SMX, co-trimoxazole).
Bellamy
Richard John
RJ
Department of Infection and Travel Medicine, James Cook University Hospital, Middlesbrough, UK.
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D053626:Atovaquone / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D053626:Atovaquone