Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV-infection
Evidence SummariesLevel of Evidence = B
Adjunctive corticosteroids appear to reduce mortality in HIV-infected patients with Pneumocystis jiroveci pneumonia.
A Cochrane review 1 included 7 small studies. Risk ratios for overall mortality for adjunctive corticosteroids were 0.56 (95% CI 0.32 to 0.98) at 1 month and 0.59 (95% CI 0.41 to 0.85) at 3–4 months of follow-up. To prevent 1 death, numbers needed to treat were 9 patients in a setting without highly active antiretroviral therapy (HAART) available, and 23 patients with HAART available. Only the 3 largest trials provided data on the need for mechanical ventilation with a risk ratio of 0.38 (95% CI 0.20 to 0.73) in favour of adjunctive corticosteroids. One study was conducted in infants, suggesting a risk ratio for death in hospital of 0.81 (95% CI 0.51 to 1.29).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).
1. Ewald H, Raatz H, Boscacci R et al. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection. Cochrane Database Syst Rev 2015;4():CD006150. [PMID:25835432]
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