No long-term effect of past Pneumocystis jirovecii pneumonia on pulmonary function in people with HIV

Abstract

Objective: To assess the impact of past Pneumocystis jirovecii pneumonia (PJP) on the pulmonary diffusion capacity in people with HIV (PWH) with a history of advanced immunodeficiency.Design: Prospective cross-sectional study.Methods: Adult PWH with past PJP >1 year ago were included as the study group. The control group consisted of PWH with a nadir CD4 þ lymphocyte count <200 cells/mm 3 , matched by age, sex, smoking status and time since HIV diagnosis. All PWH completed a pulmonary function test (PFT) consisting of pre-bronchodilation spirometry, body plethysmography and single-breath carbon monoxide transfer factor (TLCO) measurement. TLCO, diffusion impairment (defined as a TLCO Z-score <À1.645), total lung capacity (TLC) and forced expiratory volume in one second/forced vital capacity (FEV1/ FVC) Z-scores were assessed. Multivariable regression analyses were conducted with Zscores and odds of diffusion impairment as outcomes.Results: PFTs of 102 participants were analyzed, 51 of whom had past PJP with a median of 10 years since PJP. Mean TLCO Z-score and diffusion impairment rate did not differ significantly between groups (P ¼ 0.790; P ¼ 0.650). Past PJP was not independently associated with TLCO Z-score [b ¼ 0.14; 95% confidence interval (CI) À0.30-0.57], diffusion impairment (odds ratio 1.00; 95% CI 0.36-2.75) nor TLC or FEV1/FVC Z-scores, whereas current (vs. never) smoking was associated with more diffusion impairment and lower TLCO Z-scores. Conclusion:In our study, past PJP was not associated with long-term diffusion impairment. Our findings suggest that smoking plays a more important role in persistent pulmonary function impairment whereas PJP-related changes seem to be reversible.

Does Pneumocystis jirovecii pneumonia cause long-term deficits in lung function?

“…Somewhat in contrast to these findings, a study by Drummond et al [1] found that a prior history of PJP contributed to abnormal spirometry but primarily to an obstructive pattern. It is difficult to compare the study to the one by Oomen et al [8] given disparate methods and differences between study populations. Could inflammation from PJP or colonization with PJP affect large and small airways in ways that promote or exacerbate chronic obstructive lung disease, without affecting long-term capacity of alveoli to transfer oxygen?…”

“…The practical considerations in such a trial are problematic. However, a creative study by Oomen et al [8] attempted to answer the question by comparing two groups of PWH. The case group consisted of patients who had PJP more than 1 year previously and the control group included individuals with history of CD4 þ T-cell depletion, albeit no PJP, who were matched by age, sex, smoking history, and time since HIV diagnosis.…”

“…The role of steroids in preventing long-term lung injury and chronic lung disease in patients with PJP remains unresolved. Oomen et al [8] did a sensitivity analysis and found no evidence of steroid benefit in terms of the DLCO result but only a small number of patients received steroids. Whether the use of 'off-label' steroids is of benefit for preventing development of fibrosis has never been studied.…”