Recurrence of Pneumocystis carinii Pneumonia: Selective Immune Reconstitution after HAART

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, in the present case study researchers describe a patient who developed recurrent PCP <3 months after discontinuing trimethoprim-sulfamethoxazole prophylaxis (TMP-SMX).

He developed disease despite a sustained CD4 T-cell count above 200 cells/microL 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.

The authors conclude, “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.”

Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA.

Articles on HIV-related opportunistic infections (OIs)

Articles on immune restoration disease

09/20/04