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Expert Rev Anti Infect Ther. 2017 Sep;15(9):873-892. doi: 10.1080/14787210.2017.1364991. Epub 2017 Aug 21.

Treatment of Pneumocystis jirovecii pneumonia in HIV-infected patients: a review.

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a Department of Internal Medicine , National Taiwan University Hospital Hsin-Chu Branch , Hsin-Chu , Taiwan.
b Department of Internal Medicine , Po Jen General Hospital , Taipei , Taiwan.
c Department of Internal Medicine , National Cheng Kung University Hospital , Tainan , Taiwan.
d Department of Medicine , College of Medicine, National Cheng Kung University , Tainan , Taiwan.
e Department of Internal Medicine , National Taiwan University Hospital and National Taiwan University College of Medicine , Taipei , Taiwan.
f Department of Parasitology , National Taiwan University College of Medicine , Taipei , Taiwan.
g Department of Medical Research , China Medical University Hospital , Taichung , Taiwan.
h China Medical University , Taichung , Taiwan.


Pneumocystis pneumonia is a potentially life-threatening pulmonary infection that occurs in immunocompromised individuals and HIV-infected patients with a low CD4 cell count. Trimethoprim-sulfamethoxazole has been used as the first-line agent for treatment, but mutations within dihydropteroate synthase gene render potential resistance to sulfamide. Despite advances of combination antiretroviral therapy (cART), Pneumocystis pneumonia continues to occur in HIV-infected patients with late presentation for cART or virological and immunological failure after receiving cART. Areas covered: This review summarizes the diagnosis and first-line and alternative treatment and prophylaxis for Pneumocystis pneumonia in HIV-infected patients. Articles for this review were identified through searching PubMed. Search terms included: 'Pneumocystis pneumonia', 'Pneumocystis jirovecii pneumonia', 'Pneumocystis carinii pneumonia', 'trimethoprim-sulfamethoxazole', 'primaquine', 'trimetrexate', 'dapsone', 'pentamidine', 'atovaquone', 'echinocandins', 'human immunodeficiency virus infection', 'acquired immunodeficiency syndrome', 'resistance to sulfamide' and combinations of these terms. We limited the search to English language papers that were published between 1981 and March 2017. We screened all identified articles and cross-referenced studies from retrieved articles. Expert commentary: Trimethoprim-sulfamethoxazole will continue to be the first-line agent for Pneumocystis pneumonia given its cost, availability of both oral and parenteral formulations, and effectiveness or efficacy in both treatment and prophylaxis. Whether resistance due to mutations within dihydropteroate synthase gene compromises treatment effectiveness remains controversial. Continued search for effective alternatives with better safety profiles for Pneumocystis pneumonia is warranted.


Interstitial pneumonitis; alternative therapy; combination antiretroviral therapy; prophylaxis; trimethoprim-sulfamethoxazole

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