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Table 2 Summary of literature reported cases of HIV-positive patients with IRD to PCP after HAART

From: The unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: case reports and literature review

Case [Ref.] Sex/Age CD4 (/μL) & HIVRNA (log10 copies/ml) before HAART Therapy of PJP & HAART regimen Day of HAART after initiation of PCP treatment Symptoms & signs during IRD Day of IRD after initiation of HAART Day of steroid withdrawal before the onset of IRD CD4 (/μL) & HIVRNA (log10 copies/ml) during IRD Therapy of IRD & clinical outcome
1 [28] M/37 7 & 5.1 Cotrimoxazole & MP; zidovudine, lamivudine, & indinavir 16 days High fever, acute respiratory failure; CXR: patchy alveolar opacities in both upper lobes 7 days 7 days 38 & UD Restart cotri-moxazole & stop HAART; survived
2 [28] M/47 28 & 5.0 Cotrimoxazole & MP, then aerosolized pentamidine; viramune, stavudine, & didanosine 1 day High fever, acute respiratory failure requiring intubation; CXR: diffuse alveolar opacities 17 days 2 days 40 & 4.5 Restart MP & stop HAART; survived
3 [28] F/50 230 & 5.8 Cotrimoxazole & MP; zidovudine, lamivudine, & indinavir 16 days High fever, acute respiratory failure; CXR: patchy alveolar opacities in both upper lobes 7 days 7 days 564 & 3.1 Start Atovaquone, aerosolized pentamidine, & steroid; survived
4–6 [29] NM 26 & 5.5 (median) Cotrimoxazole & high dose steroid; NM 15 – 18 days (range) Swinging fever, acute respiratory failure, & radiological deterioration 5 days (median); 3–17 days (range) NM 62 & 2.87 (median) Re-introducing high dose steroids & alternative PJP therapy; all three patients survived
7 [30] M/38 4 & 5.5 Atovaquone; didanosine, efavirenz, nelfinavir, & stavudine 35 days Fever, cough, dyspnoea, & night sweats; CXR: bilateral mid & lower zone airspace shadow 14 days NA 125 & 3.6 Intravenous pentamidine & hydrocortisone; survived
8 [30] NM 70 & NM Cotrimoxazole; zidovudine      182 & NM Cotrimoxazole; survived
9 [30] NM 10 & NM Cotrimoxazole; zidovudine 21 days (median) 17–24 days (range) Fever, dyspnoea, with or without cough 15 days (median) 5–30 days (range) NM 30 & NM Supportive therapy
10 [30] NM 216 & NM Cotrimoxazole & steroid; zidovudine      340 & NM Cotrimoxazole & steroid
11 [30] NM 290 & NM Cotrimoxazole; zidovudine, & didanosine      430 & NM Cotrimoxazole
12 [30] NM 60 & NM Cotrimoxazole; zidovudine      130 & NM Supportive therapy
13 [31] M/34 46 & > 5.9 Cotrimoxazole; zidovudine, lamivudine, lopinavir-ritonavir 18 days Recurrent fever, chest discomfort, cough, & dyspneoa; CXR showed diffuse bilateral reticulonodular infiltrates 14 days NA 435 & 4.5 Cotrimoxazole (pro-phylactic dose) & keeping HAART; survived
  1. Note. CXR, chest radiograph; HAART, highly active antiretroviral therapy; IRD, immunorestitution disease; MP, methylprednisolone; NA, not applicable; NM, not mentioned; PCP, pneumocystis jiroveci pneumonia