PCP does affect large portions of the immunocompromised, particularly those who have been subjected to corticosteroids to suppress their immunity. 91% of patients without HIV that presented with PCP had been on corticosteroids in the previous month to three months. It has been shown that there is a link between corticosteroids and development of PCP.
http://www.utdol.com/online/content/abstract.do?topicKey=immuninf/10047&refNum=11-14
http://www.springerlink.com/content/g8uaa5je1tkv2ww4/
What I am trying to understand is how they would give something that supresses the immune system and is known to cause PCP to people who are immunocompromised with PCP. Particularly those with HIV.
"These drugs are very powerful and can cause such serious side effects as high blood pressure, kidney problems and liver disorders. Some side effects may not show up until years after the medicine was used. Anyone who has been advised to take immunosuppressant drugs should thoroughly discuss the risks and benefits of these medications with the prescribing physician."
"Immunosuppressant drugs lower a person's resistance to infection and can make infections harder to treat. The drugs can also increase the chance of uncontrolled bleeding. "
http://www.surgeryencyclopedia.com/Fi-La/Immunosuppressant-Drugs.html
But for some reason in incidences where PCP is acute in HIV/AIDS patients this is found to relieve them.
There is evidence of benefit for adjuvant corticosteroids in the treatment of moderate to severe PCP in people infected with HIV. There is insufficient evidence of benefit for adjuvant corticosteroids in the treatment of mild PCP in people infected with HIV. http://clinicalevidence.bmj.com/ceweb/conditions/hiv/2501/2501_I7.jsp
(this is one of several clinical studies though the others glorify them much more... )
No to mention you become more susceptible to your other infections after use of Corticosteroids as it lowers your immunity and in some instances results in declining T-Cell count... This study found that people co-infected with CMV were more likely to have severe prognosis after presenting and being treated for PCP...
"Culture of CMV in BAL was independently associated with an increased (2.7-fold) risk of short-term mortality. The clinical significance of CMV in HIV-related lung disease is an issue of controversy. Several studies323334353637 conducted before the introduction of adjunctive corticosteroid therapy concluded that CMV coinfection does not contribute directly to HIV-associated pulmonary disease. However, CMV does cause significant pulmonary disease in some individuals with HIV-1 infection, although the diagnosis frequently is missed antemortem.3839 It is possible that CMV may be a significant pathogen in patients treated with immunosuppressants or who have other infections. In one study,40 the use of corticosteroids was related to the subsequent development of CMV retinitis and colitis in HIV-1–infected patients. In a previous study41 of PCP patients treated between 1989 and 1991, we showed a twofold increased mortality rate within 3 months of diagnosis in patients treated with adjunctive corticosteroids who were BAL CMV culture positive. Patients not receiving corticosteroids who were BAL CMV negative were not at an increased risk."
http://chestjournal.chestpubs.org/content/119/3/844.full
http://www.ncbi.nlm.nih.gov/pubmed/11243967
Their are other anti-inflammatory options that do not have cortisol. And still PCP is a leading cause of death amongst those deemed HIV positive. It is the most common opportunistic infection... and one that often leads to AIDS diagnosis... Could it possibly be the treatment?
Then we discover this...
Conclusion: Adherence to CDC guidelines for adjunctive corticosteroid use varied according to city and patient sociodemographics. More importantly, improved outcomes seen in randomized controlled trials were not realized in practice. Among severely ill patients, mortality was 3-fold higher when corticosteroids were given according to CDC guidelines. Our findings suggest that that the utility of adjunctive corticosteroids in severe PCP needs to be revisited.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102195461.html
There is more to come I just find this absolutely mind boggling...
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