Respiratory failure in PCP patients can recur after HAART initiated

Recurrence of acute respiratory failure is a threat when highly active antiretroviral therapy (HAART) is initiated early after the diagnosis of AIDS-inaugurating Pneumocystis carinii pneumonia (PCP), according to Parisian investigators.

Dr. Jacques Cadranel, of Hôpital Tenon, and associates report that this phenomenon occurred in three patients out of 65 with PCP treated at a single centre between 1996 and 2000. The severe PCP, which in all three cases was the first sign of HIV infection, resolved after 15 days of parenteral cotrimoxazole and steroids.

HAART was initiated within 1 to 16 days of PCP diagnosis. As reported in the American Journal of Respiratory and Critical Care Medicine for September 1, acute respiratory failure with high-grade fever developed within 7 to 17 days. Lung biopsies and bronchoalveolar lavage revealed severe nonspecific pulmonary inflammatory foci surrounding rare P. carinii cysts.

HAART was interrupted in two patients and steroids were reintroduced in two. All three patients recovered from the respiratory failure.

Dr. Cadranel’s team reports that HAART initiation led to marked decreases in plasma viral load, but that “circulating CD4+ cell counts did not increase in parallel, suggesting possible CD4+ cell sequestration in the lungs and their participation in the acute pulmonary reaction.”