Am. J. Respir. Crit. Care Med., Vol 149, No. 6, Jun 1994, 1686-1688.
Tuberculosis in patients with HIV infection who receive corticosteroids for presumed Pneumocystis carinii pneumonia
BE Jones, EK Taikwel, AL Mercado, SU Sian and PF Barnes
Department of Medicine, University of Southern California School of Medicine, Los Angeles.
To determine if the use of corticosteroids for presumed Pneumocystis
carinii pneumonia exacerbated undiagnosed tuberculosis or increased the
likelihood of reactivation tuberculosis, we reviewed medical records of 144
hospitalized HIV-infected patients who received antipneumocystis therapy.
Ninety-four patients (Group C) received corticosteroids and 50 patients
(Group NC) did not. One hundred and thirty-seven patients (97%) had
acid-fast stains and mycobacterial cultures performed. Group C and Group NC
were similar in ethnicity, distribution of HIV risk factors and CD4 cell
count. Eight (9%) Group C patients and seven (14%) Group NC patients had
culture-proven tuberculosis during their hospitalization. After a median
followup of 16 mo after discharge, one (2%) Group C patient and two (4%)
Group NC patients developed tuberculosis. Only one patient in Group C died
of tuberculosis, despite receiving antituberculosis therapy. We conclude
that the use of corticosteroids for presumed P. carinii pneumonia does not
increase morbidity from undiagnosed tuberculosis or increase the frequency
of reactivation tuberculosis.
