Twenty-one episodes of Pneumocystis carinii pneumonia (PCP) and the acquired immune deficiency syndrome (AIDS) were treated with corticosteroids in the form of intravenous methylprednisolone or oral prednisone. A standard dose of 80 mg/day × 5 days was given for 15 episodes, whereas 6 patients received variable doses of 20–120 mg/day × 4–20 days. All were treated with trimethoprim–sulfamethoxazole (TMP–SMX). Comparison was made with 12 AIDS patients with PCP who were not treated with steroids. The steroid group was more severely ill than the controls as measured by alveolar-arterial oxygen difference but were otherwise comparable. Mortality from the pneumonia in the steroid group was (10%) vs. (25%) in the control group. Significant differences were seen in the following parameters: time to defervescence (1 day vs. > 9.3 days), the proportion of patients with pO2 > 70 mm Hg at day 5 [ (57%) vs. (9%)] and at day 10 [(90%) vs. (58%)], and number of adverse drug reactions [(19%) vs. × (75%)]. There were fewer late relapses (5%) vs. (22%)] after a 5.5 month (mean) follow-up. All patients had improvement in their clinical status when initially given corticosteroid therapy but early relapses occurred when steroids were discontinued in five patients (24%). No other complications could be attributed to steroid therapy in this study. A brief course of high-dose corticosteroids appears to be beneficial in severely ill AIDS patients with pneumocystis pneumonia. This suggests the need for randomized, double-blind, placebo-controlled trials to confirm these findings.
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