Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note for caution.

OBJECTIVE

To examine the importance of cytomegalovirus (CMV) in bronchoalveolar lavage (BAL) fluid of patients with HIV-associated Pneumocystis carinii pneumonia (PCP) treated with adjunctive corticosteroids (CS).

DESIGN

Analysis of clinical data during a 5-year period.

SETTING

Department of infectious diseases where clinical and paraclinical data on patients suspected of having PCP have been sampled prospectively.

PATIENTS

148 consecutive patients with a first episode of PCP in a 5-year period.

MAIN OUTCOME MEASURE

Vital status 3 months after diagnosis of PCP.

RESULTS

Patients with PCP treated with adjunctive CS who had CMV cultured from BAL fluid had a two times higher mortality within 3 months from bronchoscopy than others (p = 0.08). This difference could not be explained by differences in CD4 count, PO2 or PCO2 at time of bronchoscopy.

CONCLUSION

With the accepted usage of adjunctive CS in severe PCP, the role of CMV as a pulmonary copathogen may have changed. Active CMV infection may be an important cause of failing treatment of severe PCP in those treated with adjunctive CS.