HIV Patient Dies From Sepsis

This case involves a thirty-seven-year-old man, diagnosed with HIV, who presented to the emergency department with progressive shortness of breath. He complained of a productive cough with white sputum and also had a persistent, unrelenting fever. He explained to physicians that he elected to stop his HIV therapy regimen ten years ago because of the adverse effect of severe diarrhea and had not been sick until the shortness of breath. The hospital admitted the patient and started him on the standard therapy for community-acquired pneumonia due to the symptoms and supporting chest imaging. After a two-week hospital stay, the patient was transferred to the ICU due to a worsening of his condition that included sepsis and renal failure. The patient was then switched to broad-spectrum antibiotics due to an unknown cause of his lung infection. He died several days later due to an overwhelming inflammatory response and septic shock. The patient’s autopsy revealed that he suffered from complications due to Pneumocystis pneumonia, which is a fungal infection and one of the most prevalent AIDS-defining illnesses.

Question(s) For Expert Witness

1. Would an earlier treatment of the PCP pneumonia have altered this patient's outcome?

Expert Witness Response E-000983

The recommended duration of treatment for PCP is twenty-one days in patients with HIV infection and fourteen days for all other patients. Patients infected with HIV tend to have a higher organism burden and respond to treatment slower than patients without HIV infection, and require a longer duration of therapy. This patient most likely was severely immunocompromised due to the lack of HIV medications, but, nonetheless, the PCP infection should have been identified earlier in his hospital course and the appropriate treatment regimen initiated promptly.