Concern over overlapping toxicities, pill burden, and drug interactions led some clinicians to delay ART initiation in patients with AIDS-related OI. This study demonstrates that initiating early ART is beneficial.
282 patients with CD4 <200 and AIDs-related OI or severe bacterial infection randomized to early ART within 14 days or deferred ART that started after 4 weeks. Improved AIDs illnesses or deaths. The study population consisted predominantly of patients with Pneumocystis pneumonia (63%), cryptococcal meningitis (12%), and AIDS-associated bacterial infections (12%).
The actual timing of when ARTs were started was 12 vs 45 days, which argues for starting ARTs within 2 weeks and not immediately.
No difference in the occurrence of IRIS (6 vs 9%).
#Early #HIV #Opportunistic infections #Retroviral Therapy #ART #pneumocystis #OI #HAART #Mortality
Early Antiretroviral Therapy Reduces AIDS Progression/ Death in Individuals with Acute Opportunistic Infections: A Multicenter Randomized Strategy Trial – Zolopa AR, Andersen J, Komarow L, Sanne I, Sanchez A, et al. PLoS ONE 2009 4(5): e5575.
The gold standard for diagnosing pneumocystis jirovecii pneumonia is by isolating the bug itself either by DFA or culture. This task is much harder in non-HIV patients as the organism load is much lower. This meta-analysis examined 14 studies, most were retrospective. 2 only included patients with HIV, 8 with both HIV and non-HIV patients with other types of immunosuppression, and 2 with non-HIV immunosuppressed patients.
Using this pool of studies, the authors found that Fungitell had excellent sensitivity 95%, very good specificity 86%, and AUC of 97%.
+ LR 6.9 (5.1–9.3)
– LR 0.06 (0.03–0.11)
The p-value for heterogeneity was 0.31. Two studies lie clearly out of the 95% ellipse.
In cases where obtaining microbiologic samples is impossible, dangerous, or even too difficult – BD glucans may be a way to empirically treat patients with some confidence.