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Recurrence of Pneumocystis carinii pneumonia in an HIV‐infected patient: apparent selective immune reconstitution after initiation of antiretroviral therapy
Author(s) -
Crothers K,
Huang L
Publication year - 2003
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1046/j.1468-1293.2003.00170.x
Subject(s) - medicine , pneumocystis carinii , pneumocystis pneumonia , pneumonia , immunology , aids related opportunistic infections , adverse effect , antiretroviral therapy , immune system , opportunistic infection , immune reconstitution inflammatory syndrome , trimethoprim , human immunodeficiency virus (hiv) , pneumocystis jirovecii , viral disease , viral load , sida , antibiotics , microbiology and biotechnology , biology
Summary Although several studies have reported that it is safe to discontinue secondary Pneumocystis carinii pneumonia (PCP) prophylaxis in patients infected with HIV who experience a sustained immune response as a result of antiretroviral therapy, we describe a patient who developed recurrent PCP <3 months after discontinuing trimethoprim‐sulfamethoxazole prophylaxis. He developed disease despite a sustained CD4 T‐cell count above 200 cells/μL for more than 3 years while on antiretroviral therapy, as well as an apparent immune reconstitution against disseminated Mycobacterium avium complex (MAC) and Histoplasma capsulatum , for which he also discontinued therapy but without adverse effects. Thus, although increasing evidence continues to indicate that HIV‐infected patients receiving combinations of antiretroviral therapies may regain specific immunity against opportunistic infections, our patient's experience suggests that this immune recovery may be selective and incomplete.