HIV/AIDS Treatment and Care : Clinical protocols for the European ...

Table 8. pcp second-line treatment
management of opportunistic infections and general symptoms of hiv/aids
Antimicrobial agent Dose Frequency Route Duration
Clindamycin
+
primaquine
or:
Pentamidine (in combination with a
broad-spectrum antibiotic to prevent
bacterial superinfection, e.g. ampicillin +
sulbactam for 10 days)
600 mg
15 mg
4 mg/kg IV daily. Dose
reduction to 2 mg/kg after
5 days of treatment (18)
QID
BID
PO/IV
PO
21 days (17)
OD IV 21 days
• Severely ill patients will require prednisolone, 80–250 mg PO/IV daily for 1–2 weeks (reduces
interstitial oedema).
• Combination treatment should also be considered in severe cases, for example, TMP-SMZ and
pentamidine. This treatment has incurred a high risk of toxicity according to case reports only.
A severe case of PCP requires artificial ventilation or an oxygen saturation (SO 2 ) 200/mm 3 for
at least three months.
5.1.4. Other causes of pneumonia in immunosuppressed people
• Other causes of pneumonia include fungal and viral infections. They are difficult to diagnose
without sophisticated laboratory facilities and are difficult to treat.
• Viral pneumonia may be caused by herpes simplex virus, varicella-zoster virus or cytomegalovirus.
• In addition to PCP, other fungal causes of pneumonia include Histoplasma capsulatum, Cryptococcus
neoformans and Aspergillus.
5.1.4.1. Diagnosis
• When pneumonia fails to respond to standard treatment, TB or pneumonia caused by viruses,
fungi or protozoa should be suspected.
• Making a specific diagnosis of fungal or other infections requires sophisticated laboratory
tests:
° pp65 early CMV antigen from peripheral blood or bronchial lavage;
° polymerase chain reaction (PCR) for viruses of the herpes family (CMV, HSV 1/2, VZV,
Epstein-Barr virus (EBV), human herpes virus 8 and 6 (HHV8, HHV6))
° special cultures for slow-growing pathogens, such as nocardia.
• Close collaboration between physician and microbiologist is needed.
5.1.4.2. Treatment
Treatment will depend on the cause, for example foscarnet for CMV infection or long-term antibiotics
(eight weeks) for nocardia.
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