Natasha Marcella Vaselli, Kris Salaveria, James Winearls, Katherine Garnham
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引用次数: 0
Abstract
Background: Immune reconstitution inflammatory syndrome (IRIS) can occur in patients with HIV after commencing antiretroviral therapy. Tuberculosis-IRIS is the most common, and Pneumocystis jirovecii pneumonia (PJP)-IRIS accounts for only 2.7%-4% of IRIS cases. The prognosis and management of IRIS is well studied in other opportunistic infections but is ill defined for PJP-IRIS, and no guidelines exist. We reviewed the literature to consolidate the available data for PJP-IRIS to formulate recommendations for the diagnosis and management of this condition.
Methods: We performed a literature review of cases of PJP-IRIS and included cases in Australia that had not been previously published. We searched the Web of Science, MEDLINE, Embase, SCOPUS databases and grey literature sources for studies reporting cases of PJP-IRIS between January 1981 and August 2024. We provide a synthesis of published cases evaluating pathogenesis, mortality, and therapeutic options.
Results: In total, 51 patients were identified from 25 data sources. Two mortalities were described. We found that 22% of PJP-IRIS cases required support in the intensive care unit. Antimicrobial treatment for PJP was given in 32 cases, and trimethoprim-sulfamethoxazole was the most prescribed. Extending the duration of PJP therapy beyond the usual 21 days did not appear to affect outcomes. Corticosteroids were given in 26 (52%) cases, not given in 12 cases (20%), and use was not stated in 13 cases (26%). The type and dose of steroid used varied and was described in 15 cases.
Discussion: Mortality in PJP-IRIS appears lower than in IRIS secondary to other opportunistic infections. Prompt treatment with corticosteroids at a dose proportionate to disease severity is recommended. Extending antimicrobials for PJP beyond 21 days does not appear to offer clinical benefit in patients with PJP-IRIS. With the rise of immunotherapy, new treatments could be on the horizon for PJP-IRIS.
背景：免疫重建炎症综合征（IRIS）可发生在HIV患者开始抗逆转录病毒治疗后。结核病-IRIS最为常见，而耶氏肺囊虫肺炎(PJP)-IRIS仅占IRIS病例的2.7%-4%。IRIS的预后和管理在其他机会性感染中得到了很好的研究，但对于PJP-IRIS的预后和管理没有明确的定义，也没有指南。我们回顾了文献，以巩固PJP-IRIS的可用数据，以制定诊断和治疗这种疾病的建议。方法：我们对PJP-IRIS病例进行了文献回顾，包括澳大利亚以前未发表的病例。我们检索了Web of Science、MEDLINE、Embase、SCOPUS数据库和灰色文献来源，检索了1981年1月至2024年8月间报告PJP-IRIS病例的研究。我们提供了一个综合发表的病例评估发病机制，死亡率，和治疗方案。结果：共从25个数据来源中确定了51例患者。报告了两例死亡病例。我们发现22%的PJP-IRIS病例需要重症监护病房的支持。32例PJP患者给予抗菌药物治疗，以甲氧苄啶-磺胺甲恶唑处方最多。延长PJP治疗的持续时间超过通常的21天似乎没有影响结果。给予皮质类固醇26例（52%），未给予皮质类固醇12例（20%），未说明使用情况13例（26%）。使用类固醇的类型和剂量各不相同，并在15例中进行了描述。讨论：PJP-IRIS的死亡率似乎低于继发于其他机会性感染的IRIS。建议及时使用皮质类固醇治疗，剂量与疾病严重程度成比例。对于PJP- iris患者，延长抗微生物药物治疗超过21天似乎没有提供临床益处。随着免疫疗法的兴起，新的治疗PJP-IRIS的方法可能即将出现。
期刊介绍：
HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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