Current situation and mechanism of liver function injury in patients with acquired immunodeficiency syndrome combined with pneumocystis pneumonia treated by Trimethoprim sulfamethoxazole

doi:10.3877/cma.j.issn.1674-1358.2023.02.002

Abstract

Abstract:

Pneumocystis pneumonia (PCP) is a life-threatening pulmonary infection that commonly occurs in immunocompromised patients and human immunodeficiency virus (HIV)-infected patients with low CD4⁺ T cell counts, which is one of the most common opportunistic infections (OIs) in patients with acquired immunodeficiency syndrome (AIDS). For a long time, Trimethoprim sulfamethoxazole (TMP-SMZ) remains the first-line recommended treatment for PCP. It kills pneumocystis by blocking folic acid synthesis. But it has many adverse reactions such as rash, fever, hepatotoxicity, thrombocytopenia and sometimes has to be discontinued, which affects clinical treatment outcome and patient’s prognosis. Hepatotoxicity caused by TMP-SMZ in patients with AIDS in our country is not rare. It can be manifested as elevated hepatic transaminases, jaundice and even acute liver injury. This review describes the epidemiology and treatment of HIV-associated PCP and the pathogenesis of hepatotoxicity caused by trimethoprim-sulfamethoxazole, in order to provide diagnosis and treatment ideas for clinical treatment of related diseases.

Key words: Acquired immunodeficiency syndrome, Pneumocystis pneumonia, Trimethoprim, Sulfamethoxazole drug combination, Chemical and drug induced liver injury

Tongtong Wang, Chunyu Zhu, Yingchu Liu, Guiju Gao. Current situation and mechanism of liver function injury in patients with acquired immunodeficiency syndrome combined with pneumocystis pneumonia treated by Trimethoprim sulfamethoxazole[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(02): 79-83.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsyhlcgrbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-1358.2023.02.002

https://zhsyhlcgrbzz.cma-cmc.com.cn/EN/Y2023/V17/I02/79

References 35

[1]	"十三五"国家科技重大专项艾滋病机会性感染课题组. 艾滋病合并肺孢子菌肺炎临床诊疗的专家共识[J]. 西南大学学报(自然科学版),2020,42(7):49-60.
[2]	Yang JJ, Huang CH, Liu CE, et al. Multicenter study of trimethoprim/sulfamethoxazole-related hepatotoxicity: incidence and associatedfactors among HIV-infected patients treated for pneumocystis jirovecii pneumonia[J]. PLoS One,2014,9(9):e106141.
[3]	Thomas CF Jr, Limper AH. Pneumocystis pneumonia[J]. N Engl J Med,2004,350(24):2487-2498.
[4]	Stringer JR, Beard CB, Miller RF, et al. A new name (pneumocystis jiroveci) for pneumocystis from humans[J]. Emerg Infect Dis,2002,8(9):891-896.
[5]	Morris A, Lundgren JD, Masur H, et al. Current epidemiology of pneumocystis pneumonia[J]. Emerg Infect Dis,2004,10(10):1713-1720.
[6]	Bateman M, Oladele R, Kolls JK. Diagnosing pneumocystis jirovecii pneumonia: a review of current methods and novel approaches[J]. Med Mycol,2020,58(8):1015-1028.
[7]	Dunbar A, Schauwvlieghe A, Algoe S, et al. Epidemiology of pneumocystis jirovecii pneumonia and (non-)use of prophylaxis[J]. Front Cell Infect Mi,2020,10(224):1-7.
[8]	Wu L, Zhang Z, Wang Y, et al. A model to predict in-hospital mortality in HIV/AIDS patients with pneumocystis pneumonia in China: the clinical practice in real world[J]. Biomed Res Int,2019(2019):1-11.
[9]	Castro JG, Morrison-Bryant M. Management of pneumocystis jirovecii pneumonia in HIV infected patients: current options, challenges and future directions[J]. HIV/AIDS (Auckland, N.Z.),2010(2):123-134.
[10]	Huang YS, Yang JJ, Lee NY, et al. Treatment of pneumocystis jirovecii pneumonia in HIV-infected patients: a review[J]. Expert Rev Anti-Infe,2017,15(9):873-892.
[11]	唐伯莹. 卡泊芬净联合复方磺胺甲唑治疗艾滋病合并重症肺孢子菌肺炎的临床观察[J]. 中国实用医药,2021,16(36):164-167.
[12]	段江宏. 克林霉素联合复方磺胺甲噁唑分散片治疗艾滋病伴肺孢子菌肺炎患者的效果[J]. 中国民康医学,2022,34(7):18-21.
[13]	王黑豆, 许优, 加丽丽, 等. 克林霉素联合复方磺胺甲噁唑分散片治疗艾滋病并肺孢子菌肺炎的临床疗效及安全性观察[J]. 贵州医药,2021,45(1):29-30.
[14]	Sattler FR, Cowan R, Nielsen DM, et al. Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective, noncrossover study[J]. Ann Intern Med,1988,109(4):280-287.
[15]	Huang L, Cattamanchi A, Davies JL, et al. International HIV-associated opportunistic pneumonias (IHOP) study, lung HIV study; HIV-associated pneumocystis pneumonia[J]. PLoS Pathog,2011,8(3):294-300.
[16]	Helweg-Larsen J, Benfifield TL, Eugen-Olsen J, et al. Effects of utations in pneumocystis carinii dihydropteroate synthase gene on outcome of AIDS-associated p. carinii pneumonia[J]. Lancet, 1999,354(9187):1347-1351.
[17]	Kazanjian P, Armstrong W, Hossler PA, et al. Pneumocystis carinii mutations are associated with duration of sulfa or sulfone prophylaxis exposure in AIDS patients[J]. J Infect Dis,2000,182(2):551-557.
[18]	Singh Y, Mirdha BR, Guleria R, et al. Novel dihydropteroate synthase gene mutation in Pneumocystis jirovecii among HIV-infected patients in India: putative association with drug resistance and mortality[J]. J Glob Antimicrob Re,2019,6(17):236-239.
[19]	Jitmuang A, Nititammaluk A, Boonsong T, et al. A novel droplet digital polymerase chain reaction for diagnosis of pneumocystis pneumonia (PCP)-a clinical performance study and survey of sulfamethoxazole-trimethoprim resistant mutations[J]. J Infection,2021,83(6):701-708.
[20]	李丽, 李辉, 杨松, 等. 50例获得性免疫缺陷综合征合并耶氏肺孢子菌肺炎患者急诊处置分析[J/CD]. 中华实验和临床感染病杂志(电子版),2020,14(1):73-77.
[21]	曹明雪, 赵庆国. 复方磺胺甲噁唑在人类免疫缺陷病毒感染者中不良反应的研究进展[J]. 中国医院用药评价与分析,2018,18(10):1309-1311.
[22]	Lawson DH, Paice BJ. Adverse reactions to trimethoprim-sulfamethoxazole[J]. Rev Infect Dis,1982,4(2):429-433.
[23]	Greenberg S, Reiser IW, Chou SY, et al. Trimethoprim-sulfamethoxazole induces reversible hyperkalemia[J]. Ann Intern Med,1993,119(4):291-295.
[24]	Fraser TN, Avellaneda AA, Graviss EA, et al. Acute kidney injury associated with trimethoprim/sulfamethoxazole[J]. J Antimicrob Chemother,2012,67(5):1271-1277.
[25]	Miller JO, Shih AR, Mino-Kenudson M, et al. Trimethoprim-sulfamethoxazole-associated fulminant respiratory failure in children and young adults[J]. Am J Resp Crit Care,2021,203(7):918-921.
[26]	Yang JJ, Huang CH, Liu CE, et al. Multicenter study of trimethoprim/sulfamethoxazole-related hepatotoxicity: incidence and associated factors among HIV-infected patients treated for pneumocystis jirovecii pneumonia[J]. PLoS One,2014,9(9):e106141.
[27]	Kathi PR, Tama M, Ehrinpreis M, et al. Vanishing bile duct syndrome arising in a patient with HIV infection sequentially treated with trimethoprim/sulfamethoxazole and dapsone[J]. Clin J Gastroenterol, 2020,13(2):276-280.
[28]	刘维, 张雯, 赵红心. 复方新诺明在AIDS/PCP患者中引起肝损伤的相关因素分析[J]. 中国处方药,2020,18(9):77-78.
[29]	Chalasani N, Reddy KRK, Fontana RJ, et al. Idiosyncratic drug induced liver injury in African-Americans is associated with greater morbidity and mortality compared to caucasians[J]. Am J Gasteroenterol,2017,112(9):1382-1388.
[30]	Wang D, Curtis A, Papp AC, et al. Polymorphism in glutamate cysteine ligase catalytic subunit (GCLC) is associated with sulfamethoxazole-induced hypersensitivity in HIV/AIDS patients[J]. BMC Med Genomics,2012,5(32):1-9.
[31]	Smith CL, Brown I, Torraca BM. Acetylator status and tolerance of high-dose trimethoprim-sulfamethoxazole therapy among patients infected with human immunodeficiency virus[J]. Clin Infect Dis,1997,25(6):1477-1478.
[32]	Li YJ, Phillips EJ, Dellinger A, et al. Drug-induced liver injury network; human leukocyte antigen B14:01 and B35:01 are associated with trimethoprim-sulfamethoxazole induced liver injury[J]. Hepatology (Baltimore, Md),2021,73(1):268-281.
[33]	HuangYS, Liu CE, Lin SP, et al, Taiwan HIV study group; echinocandins as alternative treatment for HIV-infected patients with pneumocystis pneumonia[J]. AIDS,2019,33(8):1345-1351.
[34]	Tian Q, Si J, Jiang F, et al. Caspofungin combined with TMP/SMZ as a first-line therapy for moderate-to-severe PCP in patients with human immunodeficiency virus infection[J]. HIV Med,2021,22(4):307-313.
[35]	Ng CT, Tan CK, Oh CC, et al. Successful extracorporeal liver dialysis for the treatment of trimethoprim-sulfamethoxazole-induced fulminant hepatic failure[J]. Singap Med J,2013,54(5):113-116.

Please choose a citation manager

Content to export