Initiating antiretroviral therapy within 2 weeks of anti-Pneumocystis treatment does not increase mortality or AIDS-defining events in patients with HIV-associated moderate to severe Pneumocystis pneumonia: results of a prospective observational multicenter study
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Published:2022-08-25
Issue:1
Volume:22
Page:
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ISSN:1471-2466
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Container-title:BMC Pulmonary Medicine
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language:en
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Short-container-title:BMC Pulm Med
Author:
Zeng Yan-Ming,Li Yao,Lu Yan-Qiu,Liu Min,Nie Jing-Min,Yuan Jing,Harypursat Vijay,Zhou Yi-Hong,Qin Yuan-Yuan,Chen Xiao-Hong,Zhang Yu-Lin,Zhang De-Fa,Wang Ni,Chen Hui,Tian Qun,Zhou Yang,Qin Ying-Mei,Yang Xin-Ping,Chen Yao-Kai
Abstract
Abstract
Background
The mortality rate remains high among patients with coinfection with Pneumocystis pneumonia (PCP) and HIV. The timing for initiation of antiretroviral therapy (ART) after a diagnosis of moderate to severe PCP remains controversial, however. We therefore designed the present study to determine the optimal timing for ART initiation in AIDS-associated PCP (AIDS/PCP) patients.
Methods
This was a multicenter, observational, prospective clinical trial. Eligible participants were recruited from 14 hospitals in mainland China, and assigned to an Early ART arm (initiation of ART ≤ 14 days after PCP diagnosis) and a Deferred ART arm (initiation of ART > 14 days after PCP diagnosis). The primary outcomes were death and the incidence of AIDS-defining events at week 48. The secondary outcomes were the changes in CD4+ T-cell counts from baseline values at weeks 12, 24, and 48, the virological suppression rate at week 24 and week 48, the rate of development of PCP-associated immune reconstitution inflammatory syndrome (PCP/IRIS), and the rate of adverse events over 48 weeks.
Results
The present study was performed using the data of 363 participants, with 169 participants in the Early ART arm, and 194 participants in the Deferred ART arm. Immunological and virological outcomes were found to be similar in both treatment arms. At week 48, there were no significant differences for the incidence of mortality (20 vs. 26, p = 0.860), and AIDS-defining events (17 vs. 26, p = 0.412). Over 48 weeks, the rates of PCP/IRIS (2 vs. 3, p = 1.000), adverse events (70 vs. 72, p = 0.465), and grade 3 or 4 adverse events (28 vs. 34, p = 0.919) did not reach statistical significance. A significant difference observed between two study arms was that 11 participants (55.0%) in the Early ART arm compared to 23 participants (88.5%) in the Deferred ART arm (p = 0.026) succumbed before ART had ever been started.
Conclusions
Early ART initiation results in no increase in mortality, AIDS-defining events, IRIS, adverse events, and immunological or virological outcomes. These results support the early initiation of ART in patients with moderate to severe AIDS/PCP.
Clinical trial registration
The present trial was registered at Chinese Clinical Trial Registry (ChiCTR1900021195). Registered 1 February 2019, http://www.chictr.org.cn/showproj.aspx?proj=35362.
Publisher
Springer Science and Business Media LLC
Subject
Pulmonary and Respiratory Medicine
Reference15 articles.
1. Huang YS, Yang JJ, Lee NY, Chen GJ, Ko WC, Sun HY, Hung CC. Treatment of Pneumocystis jirovecii pneumonia in HIV-infected patients: a review. Expert Rev Anti Infect Ther. 2017;15(9):873–92. 2. Shibata S, Kikuchi T. Pneumocystis pneumonia in HIV-1-infected patients. Respir Investig. 2019;57(3):213–9. 3. Salzer HJF, Schafer G, Hoenigl M, Gunther G, Hoffmann C, Kalsdorf B, Alanio A, Lange C. Clinical, diagnostic, and treatment disparities between HIV-infected and non-HIV-infected immunocompromised patients with Pneumocystis jirovecii pneumonia. Respiration. 2018;96(1):52–65. 4. Buchacz K, Baker RK, Palella FJ Jr, Chmiel JS, Lichtenstein KA, Novak RM, Wood KC, Brooks JT, Investigators H. AIDS-defining opportunistic illnesses in US patients, 1994–2007: a cohort study. AIDS. 2010;24(10):1549–59. 5. Xiao J, Gao G, Li Y, Zhang W, Tian Y, Huang Y, Su W, Han N, Yang D, Zhao H. Spectrums of opportunistic infections and malignancies in HIV-infected patients in tertiary care hospital, China. PLoS ONE. 2013;8(10):e75915.
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