Comparison of Clinical Characteristics of Pneumocystis Pneumonia with or without Human Immunodeficiency Virus: A Prognosis Contrary to Initial Clinical Features
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Purpose: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening infection. The prevalence of PJP in patients without human immunodeficiency virus (HIV) (non-HIV-PJP) is increasing. Previous studies have separately evaluated the clinical characteristics of PJP patients with and without HIV infection. Therefore, this study aimed to comparatively analyze the clinical characteristics of PJP patients with and without HIV. Materials and Methods: We retrospectively reviewed patients with PJP who were admitted to a single tertiary center for 15 years. PJP patients were classified according to the presence or absence of HIV, and differences in their clinical characteristics and prognoses were analyzed. Forty-four HIV-PJP patients and 175 non-HIV-PJP patients were included. Results: Cough, dyspnea, typical computed tomography findings of PJP, and cytomegalovirus (CMV) pneumonitis co-infection were more common in the HIV-PJP group. The durations from symptom onset to PJ polymerase chain reaction (PCR) testing and to the start of treatment were longer in the HIV-PJP group; however, the time from the PJ PCR test to antibiotic administration was shorter in the HIV-PJP group. The 28-day survival rates were 68.6% and 88.6% in the non-HIV-PJP and HIV-PJP groups, respectively (p=0.011). The survival rate of patients with CMV pneumonitis co-infection in the non-HIV-PJP group was significantly lower. Conclusion: The clinical characteristics of patients with HIV-PJP and non-HIV-PJP were statistically different. The initial clinical features appeared to be worse in the HIV-PJP group; however, the 28-day mortality rate was higher in the non-HIV-PJP group.
Abstract
Purpose: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening infection. The prevalence of PJP in patients without human immunodeficiency virus (HIV) (non-HIV-PJP) is increasing. Previous studies have separately evaluated the clinical characteristics of PJP patients with and without HIV infection. Therefore, this study aimed to comparatively analyze the clinical characteristics of PJP patients with and without HIV. Materials and Methods: We retrospectively reviewed patients with PJP who were admitted to a single tertiary center for 15 years. PJP patients were classified according to the presence or absence of HIV, and differences in their clinical characteristics and prognoses were analyzed. Forty-four HIV-PJP patients and 175 non-HIV-PJP patients were included. Results: Cough, dyspnea, typical computed tomography findings of PJP, and cytomegalovirus (CMV) pneumonitis co-infection were more common in the HIV-PJP group. The durations from symptom onset to PJ polymerase chain reaction (PCR) testing and to the start of treatment were longer in the HIV-PJP group; however, the time from the PJ PCR test to antibiotic administration was shorter in the HIV-PJP group. The 28-day survival rates were 68.6% and 88.6% in the non-HIV-PJP and HIV-PJP groups, respectively (p=0.011). The survival rate of patients with CMV pneumonitis co-infection in the non-HIV-PJP group was significantly lower. Conclusion: The clinical characteristics of patients with HIV-PJP and non-HIV-PJP were statistically different. The initial clinical features appeared to be worse in the HIV-PJP group; however, the 28-day mortality rate was higher in the non-HIV-PJP group.