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Active pneumocystis pneumonia
Feb 10, 2000

My son was diagnosed with AIDS at the same time he came down with pneumocystis (disgnosed through bronchoscopy & samples). He was treated with Bactrim; when that produced no improvement, they started pentamidine, with Retrovir and Epivir. He is receiving 90% oxygen through a breathing tube & is fully sedated. His blood sats (oxygen) stay borderline and drop when reducing oxygen to 80%. What are the typical chances of survival in such a case? Looks dismal, as nearly as I can determine from reading internet-available literature, but not much is published on full-blown PCP. Thank you.

Response from Dr. Feinberg

The chances of survival are not fantastic in this situation, but they're not zero, either. It's hard to come up with an exact figure, but cases this severe have about a 10-20% survival rate. The lungs can sometimes be so damaged from the inflammation that the pneumonia causes, that people don't get better even though they're on the right antibiotics. The key thing here is to make sure that your son is getting steroids to decrease the inflammation-- when people are this sick the steroids are usually given IV as a drug called "methylprednisolone {Solumedrol}". The inflammation may be more important at this point than the antibiotic being used, but if you and your son's doctor aren't satisfied with his response to pentamidine, you can also try IV trimetrexate with 100 mg of dapsone by mouth, or IV clindamycin with 30 mg of primaquine base by mouth. The doses have been standardized for all these drugs and drug combinations, and are easy to find.

Another thing that can be done is to give more powerful combination medicine for HIV in the hope that that will give his immune system a boost. If they are giving your son Retrovir & Epivir (AZT/3TC), they are probably doing this through a feeding tube, and they can certainly add one or more protease inhibitors to enhance the power of the AZT/3TC given in the same way (there are no IV forms of these drugs). Good luck to both of you, and God bless.


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