Low-dose dexamethasone as adjunctive therapy for disseminated Mycobacterium avium complex infections in AIDS patients

Wormser, Gary P.; Horowitz, Harold W.; Dworkin, Brad M.

doi:10.1128/aac.38.9.2215

Cited by 18 publications

(3 citation statements)

References 15 publications

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“…There have been studies indicating the usefulness of combined antibiotic and corticosteroid treatments in humans, e.g. the management of bacterial meningitis [32,33] and even of disseminated mycobacterial infection in AIDS patients with advanced immunodeficiency [34]. Thus, indications and contraindications of short-term glucocorticoid treatment even in the case of staphylococcal infections should be reconsidered.…”

Section: Discussionmentioning

confidence: 99%

Beneficial Effect of Glucocorticoids on the Course of Haematogenously Acquired Staphylococcus aureus Nephritis

Verba¹,

Sakiniene²,

Tarkowski³

1997

Scand J Immunol

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Verba V, Sakiniene E, Tarkowski A. Beneficial Effect of Glucocorticoids on the Course of Haematogenously Acquired Staphylococcus aureus Nephritis. Scand J Immunol 1997;45:282-286 The effect of combined antibiotic and corticosteroid treatment on the course of haematogenously acquired Staphylococcus aureus nephritis was studied. Mice were given a single injection of S. aureus producing toxic shock syndrome toxin-1 in a dose capable of inducing a high frequency of inflammatory kidney lesions and divided into three groups according to a treatment regimen. In all untreated animals inflammatory infiltrates were seen in kidney cortex and medulla with high frequencies of glomerular (90%) and tubular damage (50%) as well as fibrotic changes (50%). The treatment with antibiotics alone reduced significantly only the occurrence of focal inflammatory infiltrates. In contrast, the mice treated with a combination of antibiotics and corticosteroids displayed in 64% of cases normal histological kidney appearance and a significant decrease in occurrence of glomerular (P<0.01) and tubular (P<0.05) lesions. Immunohistochemically, the combined treatment resulted in a more pronounced decrease in numbers of CD4, IL-2R (four to fivefold) and CD8 positive cells in kidney inflammatory lesions compared to antibiotics only treated group. Thus, glucocorticoids in association with antibiotics are shown to improve the outcome of septic murine nephritis, possibly due to suppression of kidney infiltrating T cells.

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Section: Discussionmentioning

confidence: 99%

Beneficial Effect of Glucocorticoids on the Course of Haematogenously Acquired Staphylococcus aureus Nephritis

Verba¹,

Sakiniene²,

Tarkowski³

1997

Scand J Immunol

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“…Patients with disseminated MAC and weight loss not responding to conventional therapy gained weight and improved symptomatically when given another corticosteroid, dexamethasone; one discontinued therapy owing to CMV retinitis.7 Reported side effects when corticosteroids have been used for other AIDS complications include onset or reactivation of candidiasis, herpetic infections, MAC disease, and CMV infections. [7][8][9] Although there appears to be a decrease in HIV RNA levels, the results observed in our study must be interpreted cautiously because of the small number of subjects involved. There was anticipated difficulty in enrolling eligible patients because of the challenges of ruling out alternative diagnoses and of carrying out serial phlebotomies in patients with severe, progressive medical conditions.…”

Section: Changes In Weightmentioning

confidence: 68%

Effects of Tapering Doses of Oral Prednisone on Viral Load among HIV-Infected Patients with Unexplained Weight Loss

Kilby

Tabereaux

Mulanovich³

et al. 1997

AIDS Research and Human Retroviruses

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In an exploratory study of virologic and immunomodulatory effects of corticosteroid therapy for wasting syndrome, four HIV-infected adults with recent unexplained weight loss were given tapering doses of prednisone over a 2-month period. Serum neopterin and TNF receptor II levels decreased from baseline after 7 days. An antiretroviral effect was observed initially, peaking on days 14-21 (mean change in HIV-1 branched chain DNA assay on day 21 of -0.52 log10; mean change, from baseline to nadir for each individual, of -0.63 log10); subsequent bDNA levels returned toward baseline as prednisone was tapered. No patient lost weight and there was a mean weight gain of 3.5 kg. Anecdotal reports of corticosteroid benefits in the wasting syndrome may result in part from decreased T cell activation leading to decreased HIV replication, an effect that may be self-limited or that may occur only at higher prednisone doses. Studies involving more targeted immunomodulatory agents for wasting syndrome are warranted.

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“…One small case series has reported that low-dose dexamethasone reduces symptoms such as fever and weight loss, but this has yet to be substantiated fully. 95 Another small case series reported an increase in monocyte activity in the blood after the co- administration of granulocyte colony-stimulating factor (gCSF) with antimycobacterial therapy, but this was not associated with a significant decrease in mycobacteremia. 96 Interferon gamma has also shown some mixed results.…”

Section: Multisystem or Disseminated Infectionsmentioning

confidence: 99%

Antimicrobial therapy for the treatment of opportunistic infections in HIV/AIDS patients: a critical appraisal

Seddon

2011

HIV

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The widespread use of antiretroviral therapy (ART) has entirely changed the management of human immunodeficiency virus (HIV) infection and dramatically reduced the rates of opportunistic infections (OI). However, OI continue to cause significant morbidity and mortality in both developed countries, where presentation with advanced HIV infection is common, and also in developing countries where ART is less widely available. Evidence to direct OI guidelines is partly limited by the fact that many large-scale studies date from the pre-ART era and more recent studies are sometimes poorly powered due to the falling rates of OI. Treatment of OI is now known to be as much about antimicrobials as about immune reconstitution with ART, and recent studies help guide the timing of initiation of ART in different infections. OI have also become complicated by the immune reconstitution inflammatory syndrome phenomenon which may occur once successful immune recovery begins. Trimethoprim-sulfamethoxazole has long been one of the most important antibiotics in the treatment and prevention of OI and remains paramount. It has a broad spectrum of activity against Pneumocystis jiroveci, toxoplasmosis, and bacterial infections and has an important role to play in preventing life-threatening OI. New advances in treating OI are coming from a variety of quarters: in cytomegalovirus eye disease, the use of oral rather than intravenous drugs is changing the face of therapy; in cryptococcal meningitis, improved drug formulations and combination therapy is improving clearance rates and reducing drug toxicities; and in gut disease, the possibility of rapid immune restitution with ART is replacing the need for antimicrobials against cryptosporidia and microsporidia.

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Low-dose dexamethasone as adjunctive therapy for disseminated Mycobacterium avium complex infections in AIDS patients

Cited by 18 publications

References 15 publications

Beneficial Effect of Glucocorticoids on the Course of Haematogenously Acquired Staphylococcus aureus Nephritis

Beneficial Effect of Glucocorticoids on the Course of Haematogenously Acquired Staphylococcus aureus Nephritis

Effects of Tapering Doses of Oral Prednisone on Viral Load among HIV-Infected Patients with Unexplained Weight Loss

Antimicrobial therapy for the treatment of opportunistic infections in HIV/AIDS patients: a critical appraisal

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