Corticosteroids improve survival of children with AIDS and Pneumocystis carinii pneumonia

Am J Dis Child. 1993 Jan;147(1):30-4. doi: 10.1001/archpedi.1993.02160250032012.


Objective: To determine if corticosteroids administered in addition to antimicrobials improve survival in children with acquired immunodeficiency syndrome and severe Pneumocystis carinii pneumonia (PCP).

Design: Before-after, nonrandomized, case-comparison study.

Setting: Pediatric intensive care unit of a tertiary care teaching hospital in Florida.

Participants: Eleven children infected with the human immunodeficiency virus (HIV) with confirmed PCP.

Selection procedure: Infants with HIV infection and acute respiratory failure due to PCP were studied sequentially.

Intervention: The first seven infants were treated with antimicrobials alone while the next four received a 2-week course of methylprednisolone sodium succinate in addition to antimicrobials.

Measurements and results: The two groups were similar with respect to age, route of HIV infection, stage of HIV disease, CD4 T-cell count, antiretroviral therapy, and respiratory parameters at intubation. All children treated with antimicrobials alone died while receiving mechanical ventilation. Survival of the children who received corticosteroid therapy was significantly improved (P < .05), and all were weaned from the ventilator.

Conclusions: Corticosteroids administered in addition to antimicrobials and supportive care improve the short-term survival of HIV-infected children who have acute respiratory failure due to PCP.

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / etiology
  • AIDS-Related Opportunistic Infections / mortality
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Blood Gas Analysis
  • CD4-CD8 Ratio
  • CD4-Positive T-Lymphocytes
  • Drug Therapy, Combination
  • Florida / epidemiology
  • HIV Infections / blood
  • HIV Infections / classification
  • HIV Infections / complications*
  • HIV-1*
  • Hospital Mortality
  • Hospitals, Teaching
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • L-Lactate Dehydrogenase / blood
  • Leukocyte Count
  • Methylprednisolone Hemisuccinate / administration & dosage
  • Methylprednisolone Hemisuccinate / pharmacology
  • Methylprednisolone Hemisuccinate / therapeutic use*
  • Pneumonia, Pneumocystis / drug therapy*
  • Pneumonia, Pneumocystis / etiology
  • Pneumonia, Pneumocystis / mortality
  • Prospective Studies
  • Respiration, Artificial
  • Respiratory Insufficiency / drug therapy*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / mortality
  • Survival Rate
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Methylprednisolone Hemisuccinate
  • L-Lactate Dehydrogenase