Table 1 Main clinical characteristics of patients
Patient 1 | Patient 2 | Patient 3 | |
|---|---|---|---|
Perinatally acquired HIV infection | Previous IDU with HIV-HCV infection | Newly diagnosed HIV infection | |
Diagnosis at admission | PJP pneumonia after HAART discontinuation | Legionella pneumophila pneumonia | PJP pneumonia |
HAART | On HAART for 21 years, multiple changes; low compliance | Compliant, multiple changes | NA |
Last HAART | Darunavir/ritonavir, etravirine, enfuvirtide and raltegravir: spontaneously stopped in 2010. | Tenofovir, lamivudine, darunavir/ritonavir | Started on 18 August: Emtricitabine/tenofovir, darunavir/ritonavir, raltegravir, maraviroc |
HIV-RNA & CD4/mm3 at admission | (HIV-RNA 386 cp/ml; T-CD4+ 196 cells/mm3), HIV-RNA: 118.330 cp/ml; CD4: 2/mm3 | (HIV-RNA suppressed; T-CD4+ 200 cells/mm3), HIV-RNA: 500 cp/ml; CD4: 170/mm3 | HIV-RNA: 50728 cp/ml; CD4: 3/mm3 |
ICU length of stay (days) | 35 | 22 | 81 |
ECMO duration (days) | 20 | 13 | 24 |
Antibiotic and antifungal treatment during ECMO | Cotrimoxazole 5 mg/kg q8h*; fluconazole 200 mg; meropenem 1gr q8h. | Cotrimoxazole 5 mg/kg q8h*; levofloxacin 500 mg q12h; rifampin 600 mg/die; pip/tazobactam 4,5 gr q6h; fluconazole 400 mg/die. | Cotrimoxazole 5 mg/kg q8h*; vancomycin 1gr q24h;metronidazole 250 mg q8h. |
On day 2 after ECMO changed to: vancomycin 750 gr bid, levofloxacin 750 mg/die, piperacillin/tazobactam 4,5 mg q6h, caspofungin 50 mg/die (with loading dose of 70 mg/die), clindamycin 600 mg q6h and primaquine per os ganciclovir 250 mg bid, due to concern for reduced plasma concentrations of cotrimoxazole | On day 10 after ECMO changed to: clindamycin 600 mg q6h; caspofungin 50 mg/die (with loading dose of 70 mg/die); primaquine per os; colistin 9 MU followed by 4.5 MU bid; meropenem 2gr tid; liposomal amphotericin B 150 mg; atovaquone 750 mg q6h | ||
After cotrimoxazole switch to clyndamicin, primaquine and caspofungin there was a slow improvement of respiratory function and ECMO was removed. | After cotrimoxazole switch to clyndamicin, primaquine and caspofungin there was an improvement of general conditions and ECMO was removed. | ||
HAART | Restarted with tenofovir/emtricitabine, raltegravir, darunavir / ritonavir, enfuvirtide and maraviroc | As above | As above |