Overview Contents Learning resources Questions

Index 5.5 Candida and other skin problems 5.6 PCP 5.7 TB

New words on this page Related websites Resources and downloads

Glossary Hide

AIDS acquired immune deficiency syndrome.

ARV anti-retroviral (drug to treat HIV infection).

CD4 count number of CD4 cells in a drop of your blood. CD4 counts are measured in cells/mm³.

diagnosis identifying the cause of an illness.

fungus parasitic organism. Includes yeast.

opportunistic infection (OI) infection that occurs after your immune system has been damaged by HIV.

parasite an animal or plant that get nutrients and support from another species.

PCP pneumocystis jiroveci (new) or pneumocystis carinii (old). A fungal infection that causes pneumonia.

prophylaxis treatment to prevent an illness.

symptom sign of illness.

There are no related websites for this page. Hide

There are no downloads for this page Hide

5 Opportunistic infections (OIs) and coinfections

5.6 PCP

Type of infection

PCP stands for pneumocystis jiroveci (new – say: yee-row-vet-zee) or pneumocystis carinii (old). PCP is caused by a relatively common organism that behaves like a fungus.

PCP is mainly a lung infection – a pneumonia.

A CD4 count of under 200 cells/mm³ puts you at higher risk of PCP. It is rare at higher CD4 counts. Most cases of PCP occur in people with a CD4 count under 100 cells/mm³.

Main symptoms

Difficulty breathing (shortness of breath), tightness in the chest
Dry cough
Feeling tired, fever and weight loss.

Symptoms in an HIV-positive person with a low CD4 count are sufficient to start treatment.

PCP can sometimes grow in other area of the body like the bones and eye. This is rare.

Diagnosis

Analysis of sputum from either bronchoscopy or 'induced' sputum (after breathing salty mist which brings up fluid from deeper in the lungs) is used for definite diagnosis.

Treatment

First-line treatment: co-trimoxazole (Septrin, Bactrim, TMP-SMX). Co-trimoxazole is made up of two drugs trimethoprim (TMP) and sulphamethoxazole (SMX). Standard doses are TMP 15-20 mg per kg body weight a day + SMX 75 mg per kg body weight a day, by continuous drip or 3-4 injections a day for 3-4 days, followed by tablets.
Other treatments: trimethoprim plus dapsone, pentamidine, trimetrexate, atovaquone and clindamycin plus primaquine.

Prophylaxis

Prophylaxis against PCP, at a lower dose that used for treatment, is recommended for anyone with a CD4 count below 200 cells/mm³ whether or not they are using ARVs.

Co-trimoxazole (Septrin or Bactrim) at 960mg/day is the most widely used prophylaxis.

Other prophylaxis used when co-trimoxazole causes side effects or if resistance has developed: dapsone (often has side effect in people who cannot tolerate co-trimoxazole), aerosolised pentamidine (every 2-4 weeks), atovaquone, sulphadiazine plus pyrimethamine and dapsone plus pyrimethamine.

Prophylaxis can be safely stopped at a CD4 count over 200 cells/mm³.

Prophylaxis for PCP with co-trimoxazole protects against other infections including toxoplasmosis.

Treatment training for advocates