indinavir-sulfate and Pneumonia--Pneumocystis

Pneumocystis jirovecii pneumonia has historically been one of the most common opportunistic pneumonias and life-threatening infectious complications in HIV-infected patients. After the introduction of combination antiretroviral therapy, the incidence of Pneumocystis pneumonia and other opportunistic infections has decreased dramatically. Nowadays Pneumocystis pneumonia still occurs in patients unaware of their HIV status, in those not receiving combination antiretroviral therapy, or in those in whom it is ineffective due to resistance. Age factor is the diagnosis delaying one: patients aged more than 50 years are diagnosed with AIDS later than younger persons. Pneumocystis was thought to be a species of protozoa. Over the last 20 years, Pneumocystis has been shown to be a fungus, to be genetically diverse, host species specific, to colonize individuals with minor immunosuppression, and to cause clinical disease by "new" infection in addition to reactivation of latent childhood-acquired infection. Recently, the microorganism Pneumocystis carinii causing disease in humans has been renamed to Pneumocystis jirovecii. This article presents a clinical case of late diagnosis of Pneumocystis jirovecii pneumonia in a 62-year-old patient unaware of her HIV status and a review of literature reflecting epidemiological issues of Pneumocystis jirovecii and latest discoveries related to Pneumocystis as well as the rationale for renaming it.

Topics: AIDS-Related Opportunistic Infections; Anti-Infective Agents, Urinary; Antifungal Agents; Drug Combinations; Drug Therapy, Combination; Female; Fluconazole; Folic Acid Antagonists; HIV Protease Inhibitors; Humans; Indinavir; Lamivudine; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Radiography, Thoracic; Trimethoprim; Zidovudine

Topics: Abdomen; Adipose Tissue; Adult; Anti-HIV Agents; Body Composition; Female; HIV Infections; HIV-1; Humans; Indinavir; Pneumonia, Pneumocystis; Protease Inhibitors

To analyse the characteristics of opportunistic infections in patients receiving highly active antiretroviral treatment (HAART).. A retrospective study performed in seven hospitals, included all patients starting treatment by ritonavir or indinavir between 26 March and 31 December 1996. Patients were evaluated for the development of AIDS-defining events. Clinical evaluation, plasma HIV-1 RNA quantification, CD4 cell count were recorded at baseline and at the onset of the event.. Four hundred and eighty-six patients were included: 44.2% had a CD4 cell count below 50 x 10(6) cells/l. Fifty clinical events were recorded in 46 patients with a mean follow-up of 6.1 months, of which 34 events (68%) were observed during the first 2 months of HAART. Eighteen of these occurred despite a reduction of viral load by at least 1.5 log10) and a 100% increase of the CD4 cell count compared with that at the onset of the event, corresponding to 11 cytomegalovirus infections, five mycobacterial infections, one case of cryptococcosis, and one case of Varicella-Zoster virus-related acute retinal necrosis. Among the 16 events observed after the second month, six occurred despite a marked biological improvement, corresponding to a recurrence in five of six patients who had stopped their maintenance therapy. Events were one cytomegalovirus infection, two mycobacterial infections, one episode of oesophageal candidiasis and one cryptococcal meningitis.. In patients at high risk of developing an opportunistic infection prior to the institution of a HAART regimen, prophylaxis should not be discontinued during the first 2 months of treatment, and maintenance therapy should be carried on despite a significant increase in the CD4 cell count.

Topics: AIDS-Related Opportunistic Infections; Anti-HIV Agents; Candidiasis; CD4 Lymphocyte Count; Cryptococcosis; Cytomegalovirus Infections; Disease Progression; Drug Therapy, Combination; HIV Infections; HIV Protease Inhibitors; HIV-1; Hospitals, University; Humans; Indinavir; Mycobacterium Infections; Pneumonia, Pneumocystis; Retrospective Studies; Ritonavir; RNA, Viral; Toxoplasmosis, Cerebral; Viral Load

A case study is presented of a 27-year-old male, in the late stages of AIDS, who benefitted from recent advances in HIV therapy. During recovery from his fourth episode of pneumocystis pneumonia and newly-diagnosed disseminated Mycobacterium avium (MAC) infection, he agreed to take antiretrovirals. He received treatment with indinavir, Epivir, and stavudine, and then had stavudine replaced with AZT due to adverse effects. He also received treatment for MAC. His diarrhea and fevers disappeared, his appetite returned, and he gained 50 pounds. A tinea infection on his back and face resolved, as did persistent oral candidiasis. Although HIV myelitis was suspected during treatment, it stabilized, or even improved. The patient became discouraged when his viral load rose from 2,100 to 5,700, and trying to make him understand that his initial loads were probably near a million copies did not reassure him. Referral to a clinical psychologist seemed to help, and he continues to do well on therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-HIV Agents; Counseling; HIV Protease Inhibitors; Humans; Indinavir; Lamivudine; Male; Mycobacterium avium-intracellulare Infection; Pneumonia, Pneumocystis; Reverse Transcriptase Inhibitors; Stavudine; Treatment Outcome; Zidovudine