Epidemiology and Long-Term Survival in HIV-Infected Patients With Pneumocystis jirovecii Pneumonia in the HAART Era

Abstract

As highly active antiretroviral treatment (HAART) is widely available, the incidence of Pneumocystis jirovecii pneumonia (PJP) has decreased significantly but still represents a significant cause of morbidity and mortality in developed countries.We analyzed all the cases with PJP in human immunodeficiency virus (HIV)-infected patients from 2000 to 2013 in a university hospital in Barcelona, Spain, and conducted a systematic literature review to evaluate data regarding incidence, mortality, and long-term survival after PJP in developed settings.One hundred thirty-six episodes of PJP were analyzed. During the study period, the incidence decreased significantly (from 13.4 cases/1000 patients-year to 3.3 cases/1000 patients-year, P < 0.001). Oppositely, median age of the patients increased from 34 years in 2000 to 45 in 2013 (P = 0.024). PJP preceded HIV diagnosis in nearly 50% of the cases. Fifteen (11%) patients died during the PJP episode. The main risk factor for in-hospital mortality in our cohort was age >50 years (odds ratio 4.96, 95% confidence interval [CI] 1.45–15.14). Patients who survived were followed-up during a mean time of 44 months. Overall 5-year survival of patients after hospital discharge was 73%. Survival likelihood was 54% higher (88% [95% CI 81–96]) among HAART-adherent patients.Mean age and the proportion of patients with unknown HIV infection at the time of PJP diagnosis have increased in developed countries in the HAART era. Although the incidence has decreased, in-hospital mortality remains stable in this setting. Long-term survival is very high among HAART-adherent patients.

Changing Trends in the Epidemiology and Risk Factors of Pneumocystis Pneumonia in Spain

“…The incidence observed is lower than that found in previous studies carried out in the Spanish region of Andalusia in the 1988–1999 period (34 cases per million inhabitants) (20). These findings are explained by the decrease in HIV-infected patients after the generalization of the HAART treatment and are in line with other epidemiological studies carried out in Spain (21) and Europe (4, 11, 22).…”

Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients

“…Since the use of the HAART and prophylaxis, the number of HIV ϩ patients affected by PCP has decreased, but for some patients, P. jirovecii pneumonia still precedes a diagnosis of HIV infection and is still a cause of mortality (1,2,64). PCP occurs in patients with a lack of access to medical care or unaware of their HIV infection status, as was the case for 12 of 14 HIV ϩ patients in the present study.…”

CD4+ T cell lymphopenia predicts mortality from Pneumocystis pneumonia in kidney transplant patients

“…A low CD4 + cell count as a determinant of higher mortality in HIV patients has been demonstrated in many large datasets 19,20 . In five smaller datasets, one showed significant, two non‐significant, and two no differences 17,37‐40 . Such disagreement could potentially be explained by the already very low baseline CD4 + cell counts (median values ranging between 19 and 40 cells/µL) in HIV patients with PCP in these studies.…”