• New HIV/AIDS in the U.S.
  • In 2015, 39,513 people were diagnosed with HIV infection in the United States. 
  • The number of new HIV diagnoses fell 19% from 2005 to 2014
  • In 2015, 18,303 people were diagnosed with AIDS
  • In the MSM population in the U.S. prevalence of HIV is 25% in Whites and 50% in Blacks
  
  

  Posted 01/12/17 09:52:56 AM by Ying Liu

• Diagnosing PCP
  • Sub-acute course
  • Severe hypoxia and respiratory distress
  • CXR findings that can be normal or have the classic reticulonodular pattern. Effusions rule out PCP
  • Elevated LDH and fungitell are helpful
  • BAL with silver staining is gold standard
  
  

  Posted 01/12/17 09:54:04 AM by Ying Liu

• Treatment of PCP
  • Sulfamethoxazole – trimethoprim (Bactrim)
    • Single-strength tablet (sulfamethoxazole 400 mg; trimethoprim 80 mg)
    • Double-strength tablet (sulfamethoxazole 800 mg; trimethoprim 160 mg)
    • Mild to moderate: Oral: 15 to 20 mg TMP/kg/day in 3 divided doses for 21 days or alternatively, 320 mg TMP 3 times/day for 21 days
    • Moderate to severe: IV: 15 to 20 mg TMP/kg/day in 3 to 4 divided doses for 21 days; may switch to oral therapy after clinical improvement
  • Alternate Regimens:
    • Clindamycin and Primaquine
    • Atovaquone (mild disease)
    • Pentamidine
  • Important to start HAART therapy concurrently
  
  

  Posted 01/12/17 09:54:46 AM by Ying Liu

• Steroids and PCP (NEJM 1990 trial)
  • 333 patients with AIDS and PCP receiving standard treatment
  • Randomized to prednisone 40mg twice daily or no additional therapy
  • Steroid group had a lower cumulative 31 day risk of respiratory failure and death as well as death within 84 days
  • Only in those with moderate to severe PCP (PAO2 <70)
  
  

  Posted 01/12/17 09:56:01 AM by Ying Liu

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