Severity and outcomes of Pneumocystis pneumonia in patients newly diagnosed with HIV infection: An observational cohort study

Abstract

It is unclear whether patients who are unaware of their HIV infection have different severity or outcomes of Pneumocystis pneumonia (PCP) compared to patients who have been previously diagnosed with HIV. In this retrospective observational cohort study of consecutive HIV-infected patients with microscopically diagnosed PCP at San Francisco General Hospital between 1997 and 2006, 121 of 522 patients (23%) were unaware of their HIV infection prior to their diagnosis of PCP. The proportion of patients with concurrently diagnosed HIV and PCP each year remained unchanged during the study period. Patients with newly diagnosed HIV had a significantly higher alveolar-arterial oxygen gradient at presentation (median 51 versus 45 mm Hg, p=0.03), but there were no differences in mortality, frequency of mechanical ventilation, or admission to intensive care compared to patients with previously diagnosed HIV infection. In multivariate analysis, patients who reported a sexual risk factor for HIV infection were more likely to be newly diagnosed with HIV than patients who reported injection drug use as their only HIV risk factor (odds ratio = 3.14, 95% confidence interval 1.59–6.18, p = 0.001). This study demonstrates a continued need for HIV education and earlier HIV testing, particularly in patients with high-risk sexual behavior.

Clinical and translational research inPneumocystisandPneumocystis pneumonia

“…Most of these cases occurred in persons who were not receiving antiretroviral therapy or PcP prophylaxis and many were actually unaware of their HIV infection at the time of presentation (Fei et al , 2009). This experience is similar at other institutions, where 23-31% of reported PcP cases occurred in persons who were newly diagnosed with HIV infection at the time of PcP (Fei, et al , 2009a; Radhi et al , 2008; Walzer et al , 2008). Thus, increased efforts to test persons at risk of HIV, to engage HIV-infected persons in regular medical care, and to initiate and adhere to combination antiretroviral therapy and PcP prophylaxis are important strategies to decrease the incidence of the disease.

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HIV-Associated Pneumocystis Pneumonia

“…At San Francisco General Hospital, nearly 1,000 cases of HIV-associated PCP were microscopically diagnosed from 1990 to 1993 (average, 250 cases per year) (Figure 1) (20). This experience is similar at other institutions, where 23 to 31% of reported PCP cases occurred in patients who were newly diagnosed with HIV infection at the time of PCP (21,23,24). Most of these cases occurred in persons who were not receiving antiretroviral therapy or PCP prophylaxis, and many were unaware of their HIV infection at the time of presentation (21,22).…”

New advances in understanding the host immune response to Pneumocystis

“…Medical lengths of stay were estimated at 8 to 9 days in HIV+ cases [15], which translated into an estimated annual healthcare burden of over $1B in the US alone. Moreover there are likely sub-clinical cases that were not captured in these types of data.…”