Corticosteroids Therapy and Pneumocystis Jirovecii Pneumonia (PCP)
Corticosteroids Therapy and Pneumocystis Jirovecii Pneumonia (PCP)
To explore the effects of corticosteroid therapy on pulmonary fibrosis and potentially
 pneumothorax in patients with mild PCP (pO2 >70mmHg) combined with the standard of care
 treatment of antibiotic therapy.
Although the development of highly active anti-retroviral therapy has substantially reduced
 the incidence of Pneumocystis jirovecii pneumonia (PCP) among HIV-infected individuals, PCP
 remains one of the most common presenting opportunistic infection among this population. The
 use of adjunctive corticosteroids in the treatment of patients with moderate to severe PCP
 has resulted in a significant improvement in the development of respiratory failure and
 mortality.

 Past studies have demonstrated no clinical benefit in patients with mild disease (pO2>75 torr
 on room air). This may have been due to the fact that few patients with mild disease develop
 either respiratory failure or die during the course of the acute illness so that a
 statistical difference could not be demonstrated.

 However, considering parameters other than mortality, there is some evidence to suggest that
 patients with high pO2 concentrations benefit from adjunctive corticosteroids. PCP is
 associated with the development of pulmonary fibrosis and this can have significant
 consequences. Pathological studies have shown the development of interstitial fibrosis late
 in the course of acute illness. Studies have documented the presence of diffuse interstitial
 pneumonitis five months after the onset of acute illness. Therefore, patients with PCP
 infection, regardless of their pO2 level on presentation may benefit from corticosteroid
 therapy.

 The current standard of care therapy for patients with PCP does not involve the addition of
 corticosteroids to standard antibiotics in those patients with pO2>70 mmHG. This study
 propose to conduct a randomized, prospective, un-blinded clinical trial to explore the
 effects of corticosteroid therapy on pulmonary fibrosis in patients with mild PCP who are
 admitted to the George Washington University Hospital.
Inclusion Criteria:

 -  HIV Infection,

 -  Hospital admission for suspected PCP,

 -  Confirmatory test for PCP (bronchoscopy with bronchoalveolar lavage), pO2>70 mmHg or
 pO2<70 mmHg while breathing room air,

 -  18 years or older

 Exclusion Criteria:

 -  Contraindications to corticosteroid therapy,

 -  Unable and or unwilling to perform PFTS or to return for follow-up evaluations,

 -  Underlying lung disease such as emphysema, untreated active tuberculosis, Uncontrolled
 diabetes (fasting glucose > 250 mg/dL,

 -  Uncontrolled hypertension (160/95 mmHg),

 -  Pregnancy