# When Antiretroviral Therapy Is Not Enough: A Case Series of Pneumocystis Pneumonia With Pulmonary Complications in HIV-Positive Patients

## TL;DR

This paper presents two cases of HIV-positive patients who developed severe lung complications from Pneumocystis pneumonia despite being on antiretroviral therapy.

## Contribution

The study highlights the risks of poor ART adherence and the importance of timely diagnosis and comprehensive treatment in managing PJP in HIV-positive patients.

## Key findings

- Two HIV-positive patients with Pneumocystis pneumonia had severe pulmonary complications.
- Both patients improved with high-dose co-trimoxazole, corticosteroids, and ART.
- Poor ART adherence and comorbidities increase the risk of severe PJP outcomes.

## Abstract

Pulmonary opportunistic infections remain a major cause of morbidity in people living with HIV (PLHIV), especially with poor antiretroviral therapy (ART) adherence or comorbidities. Pneumocystis jirovecii pneumonia (PJP) is a frequent and life-threatening infection that may be complicated by bacterial superinfections or post-tubercular sequelae.

We describe two HIV-positive adults with severe pulmonary involvement. The first, a 38-year-old man with interrupted ART, presented with hemoptysis, fever, and oral ulcers. Cluster of differentiation 4 (CD4) count was 80 cells/mm³; sputum showed P. jirovecii cysts, and culture grew Pseudomonas aeruginosa. High-resolution computed tomography (HRCT) revealed fibrocavitary post-tubercular changes with superinfection. The second, a 55-year-old woman with diabetes and hypertension on ART, developed hypoxemic respiratory failure; sputum confirmed PJP with bilateral infiltrates on imaging. Both improved with high-dose co-trimoxazole, corticosteroids, ART, and supportive care.

These cases highlight the persistent burden of PJP in PLHIV, the risks of poor ART adherence, and the role of timely diagnosis and comprehensive management in improving outcomes.