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

• Published in: Scandinavian journal of infectious diseases 2009, Vol.41 (9), p.672-678
• Main Authors: Fei, Matthew W., Sant, Catherine A., Kim, Eunice J., Swartzman, Alexandra, Davis, J. Lucian, Jarlsberg, Leah G., Huang, Laurence
• Format: Article
• Language: English
• Subjects: Adult; Antibiotic Prophylaxis; Antifungal Agents - therapeutic use; Biological and medical sciences; Cohort Studies; Female; HIV Infections - drug therapy; HIV Infections - microbiology; HIV Infections - psychology; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical sciences; Middle Aged; Multivariate Analysis; Pneumocystis; Pneumology; Pneumonia, Pneumocystis - drug therapy; Pneumonia, Pneumocystis - psychology; Pneumonia, Pneumocystis - virology; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0036-5548; 1651-1980
• DOI: 10.1080/00365540903051633

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 vs 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% CI 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.