Background: Pneumocystis jirovecii pneumonia (PJP) remains an important cause of morbidity and mortality in HIV-infected patients. In case of severe hypoxemia, corticosteroids are added to the antibiotic therapy. As corticosteroids are known to cause lymphocytopenia, there are concerns that corticosteroid use will cause slower CD4 cell count increase after commencement of combined antiretroviral therapy (cART). The aim of this study was to evaluate CD4 cell count recovery after adjunctive corticosteroid treatment in ART-naïve HIV-infected patients with PJP starting cART.
Methods: HIV-infected patients who presented with PJP in the University Medical Center Utrecht (Utrecht, The Netherlands) between 1996 and 2015 were included in this retrospective study. Demographic and laboratory data, details on ART and corticosteroid treatment were retrieved from the hospital charts. The primary outcome was the difference in mean CD4 count increase between the corticosteroid-treated (CS) group and the non-corticosteroid (non-CS) group after 1-year follow-up. The association between corticosteroids and CD4 cell count increase was evaluated with linear mixed model adjusted for baseline CD4 counts, age and gender. Secondary outcomes were the time needed to achieve plasma HIV-RNA < 400 copies/mL, and 1-year mortality and recurrence of or new opportunistic infections (OIs).
Results: Sixty-two patients (n=36 in the CS- and n=26 in the non-CS group) were included. The groups were matched at baseline except the more profound hypoxemia in the CS-group. There was no significant difference in the mean increase of CD4 cell counts at 1-year follow-up between the CS and non-CS group (243 versus 222; p=0.60). There was no significant association between the corticosteroid use and the increase in the CD4 count (p=0.41). Furthermore, there was no significant difference in the time to achieve HIV RNA < 400 copies/mL and occurrence of OIs between both groups in the first year after PJP diagnosis. All patients were alive at the end of follow-up.
Conclusions: No deleterious effect of adjunctive corticosteroids on CD4-cell count was seen in our cohort of HIV patients with PJP. It is reassuring for the treating physicians to know that this short course of corticosteroid therapy does not put these vulnerable patients at risk for future OIs.