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For the past several weeks, readers and experts have been discussing how they would manage a patient who developed acute renal failure in the setting of newly diagnosed AIDS and suspected Pneumocystis jirovecii pneumonia (PCP). Now, we reveal how the case was actually handled.
The patient was thought to have mild HIV-related PCP and acute tubular necrosis caused by trimethoprim-sulfamethoxazole. His PCP treatment was changed to atovaquone, and his antiretroviral regimen was changed to ritonavir-boosted darunavir + raltegravir. A (1→3) ß-d-glucan test returned at >500 pg/mL, strongly suggestive of PCP. His renal function gradually improved, and when seen in follow-up approximately 3 months later, his serum creatinine level had returned to normal. He was switched to tenofovir/FTC/efavirenz (Atripla) and has had no significant side effects or changes in renal function during the first 6 months of treatment.