Abstract Human immunodeficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS) continue to pose a significant health burden, affecting approximately 36 million people worldwide. Pneumocystis pneumonia (PCP) has long been recognized as a serious health concern within this population. Earlier diagnosis of HIV, the availability of antiretroviral therapy, and effective prophylaxis have all contributed to a 75% decline in PCP cases. Hospitalization rates among HIV-positive individuals remain higher than those of the general population. Our case is a 67-year-old female with hypertension, hyperlipidemia, and HIV who presented with a productive cough, progressive dyspnea on exertion, odynophagia, dysphagia, and oral thrush. Patient was previously on Darunavir-Cobicistat-Emtricitabine-Tenofovir alafenamide, and later switched to Bictegravir-Emtricitabine-Tenofovir alafenamide. However, the patient was not compliant with her medications, stating that she was hearing voices telling her not to. The patient also complained of visual hallucinations. Viral load was 35,318 copies/milliliter. CD-4 count was 20 cells/microliter (20%). Chest imaging showed ground-glass opacities in the right upper lobe and portions of the left upper lobe, and additional reticular opacities in the lung bases. Patient was initially started on Ceftriaxone and Doxycycline for community-acquired pneumonia, and Sulfamethoxazole-Trimethoprim (TMP/SMX) and oral corticosteroid to cover for PCP. Patient’s sputum sample resulted positive for Pneumocystis jirovecii DNA on RT-PCR on hospital day 5, and diagnosis was confirmed. On hospital day 8, the patient’s respiratory status worsened. The patient was put on high-flow nasal cannula and closely monitored. TMP/SMX was switched to Clindamycin and Primaquine, and intravenous corticosteroid was given. Antiretroviral therapy was also restarted during the hospital stay. Patient was discharged with Clindamycin, Primaquine, and Prednisone to complete a 21-day course. Patient was scheduled to continue Atovaquone for prophylaxis afterward and to follow up with the infectious disease specialist for HIV and the psychiatrist for psychosis disorder. Our case highlights the importance of addressing social and mental health care to improve adherence to HIV medications. Mental health diagnoses or symptoms can act as barriers to retaining patients in HIV care, making it crucial to provide mental health treatment for those in need. Clinical deterioration may occur during the first 4 to 8 days of treatment. This does not typically indicate immune reconstitution inflammatory syndrome (IRIS) or treatment failure. It is likely due to an inflammatory response caused by the antimicrobial-induced lysis of organisms in the lungs. Patients can deteriorate rapidly during treatment, so close monitoring of respiratory rate and arterial oxygen levels is essential. This abstract is funded by: None
Naing et al. (Fri,) studied this question.