UCSD Study Finds Steroid Curbs AIDS-Caused Illness
An inexpensive steroid drug can halve the number of deaths each year from AIDS-related pneumonia, a study led by UC San Diego doctors has concluded.
The state-funded study, done at eight hospitals throughout California, found that the anti-inflammatory drug prednisone prevents the condition of Pneumocystis carinii pneumonia patients from worsening in the first few days after antibiotic therapy begins.
The study was presented Saturday at the Sixth International Conference on AIDS in San Francisco.
“What generally happens is that people continue to get worse for a few days after standard antimicrobial therapy begins. The median time to improvement is four to six days,” said Dr. Samuel A. Bozzette, a UCSD assistant clinical professor of medicine who led the study.
It is during this continued drop in their breathing capacity that many Pneumocystis patients die.
“I think it’s an important study, that it will save lives--not in the dozens, but in the thousands,” said Dr. J. Allen McCutchan, another UCSD investigator in the study.
Pneumonia from Pneumocystis, a bacterium, is the most common opportunistic infection striking AIDS patients in the United States.
About 40,000 people with AIDS become ill with Pneumocystis every year, and about 15% of them die from the infection, McCutchan explained. That means at least 3,000 would be saved from death by the prednisone treatment, he said.
Its results are so striking that doctors involved in the study already have adopted steroids as their standard therapy for moderate to severe Pneumocystis patients, Bozzette said.
The results also are being considered by a National Institutes of Health consensus panel on AIDS treatment, he added.
Unlike research with other drugs, there is little financial gain at stake for drug companies,Bozzette said. A month’s supply of prednisone for Pneumocystis therapy would cost about $10.
“This was a study for which drug company sponsorship was impossible. There’s no money to be made from this,” Bozzette said. “Corticosteroids are generic. They’re about as expensive as potting soil.”
The research was done by the California Collaborative Treatment Group, a state-funded AIDS drug-trial cooperative intended to address AIDS therapy questions considered important to California. Cooperating institutions are UCSD, the University of Southern California, UC Irvine and Stanford University.
Researchers at the four centers conducted the trial on 333 people with AIDS, 142 of them at UCSD, who were treated for moderate-severity Pneumocystis at eight different hospitals throughout California.
About half of the patients received prednisone within 36 hours of the onset of antibiotic therapy, and the others received only antibiotics. (However, patients in the antibiotics-only group who showed signs of oxygenation failure were given prednisone immediately.)
In the antibiotics-only group, 23% were dead within 31 days of treatment beginning. In the prednisone group, 11% were dead within 31 days.
After 84 days the difference was smaller: 26% of the antibiotics-only group had died by then, and 16% of the prednisone group had died.
Importantly, Bozzette said, there was no significant difference in recurrence of Pneumocystis between the survivors in both groups. Some doctors had been concerned that prednisone, because it is known to suppress the immune system, would make AIDS patients more likely to get pneumonia again.
“The clinical model and perception was that steroids are immunosuppressive and should be reserved for those people who get very, very ill,” McCutchan said. “We looked very carefully (for harmful side effects). There were a few minor problems, but they were more easily treated (than Pneumocystis).”
Other principal investigators in the study were Fred Sattler, USC; Joseph Chiu, UC Irvine; Daniel Gluckstein, Kaiser-Sunset Hospital in Los Angeles; and Carol Kemper, Santa Clara Valley Medical Center.
Bozzette speculates that the prednisone keeps lung function from deteriorating in the pneumonia patients by stopping the lungs’ inflammatory response to the antibiotics.
“When you start treatment you break up the organisms, and this causes inflammation of the air spaces in the lungs,” he said. “The air spaces are filled with inflammatory fluid, and the little thin membranes through which oxygen is absorbed are swollen.”
