Short-term Steroid Therapy in Patients With P. Jirovecii Pneumonia Due to HIV / AIDS

• Status: Enrolling by invitation
• Trial end date: 2023-02-01
• Target enrollment: 0
• Participant gender: All

Summary

The treatment guidelines for Pneumocystis pneumonia (PCP) suggest adding 40mg of prednisone (or its equivalent in methylprednisolone) twice per day on days 1 through 5, 40 mg days 6 through 10, and 20 mg daily on days 11 through 21 in subjects with moderate and serious PCP. Steroids have shown to improve clinical outcome and reduction in mortality in HIV-infected patients the effectiveness of adjuvant steroid treatment for PCP has been observed if it starts within the first 24 to 48 hours. Possibly, there is a long-term benefit with their use in the recovery of function and limitation of chronic pulmonary complications; recently, benefits have been observed in decreasing the incidence of Inflammatory Immune Reconstitution Syndrome (IRIS) due to Mycobacterium tuberculosis. On the other hand, steroids could increase the morbidity related to adverse reactions as well as paradoxical worsening of associated herpes virus infection, which are attributed to IRIS or as a result of immunosuppression generated by their use. Recently, it has been shown that gradually steroids withdrawal is not necessary in patients who have received less than 21 days of treatment.

This non-inferiority work aims to confirm the null hypothesis that a reduced steroid scheme in patients with moderate PCP (8 days) and severe pneumonia (14 days) is sufficient to limit long-term ventilatory complications and acute postinflammatory syndrome, compared to the conventional 21-day scheme. It also has been hypothesized that it could be associated with fewer cases of IRIS due to herpes virus type 1,2,3 and 8.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Centro de Investigación en. Enfermedades Infecciosas, Mexico
• Treatments: Methylprednisolone; Methylprednisolone acetate; Methylprednisolone Hemisuccinate; Prednisolone; Prednisolone acetate; Prednisolone hemisuccinate; Prednisolone phosphate

Criteria

Inclusion Criteria:

• Older than 18 years

• To have a gasometry at the admission that confirms moderate or severe PCP.

• Patients receiving trimethoprim / sulfamethoxazole in doses of 15 to 20 mg / kg per day from the first 24 hours after admission.

• Patients who have begun adjuvant treatment with steroids in the first 48 hours after admission.

• No history of chronic pulmonary disease.

• APACHE at hospitalization less than 20 points.

Exclusion Criteria:

• Allergic to TMP/SMX, who have not tolerated desensitization.

• History of inflammatory, infectious, autoimmune or neoplastic diseases except Kaposi's sarcoma, which merit the chronic use of steroids.

• Pleural or pericardial effusion and meningitis from any cause.

• Septic shock not related to PCP.

• Subjects who during the hospitalization have been diagnosed with any neoplasia (except Kaposi´s sarcoma)