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Pneumocystis jirovecii pneumonia in HIV-1-infected patients in the late-HAART era in developed countries

Llibre, Josep M. et al.

Scandinavian journal of infectious diseases. Volume 45:Number 8 (2013, August); pp 635-644 -- Informa Healthcare

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  • Title:
    Pneumocystis jirovecii pneumonia in HIV-1-infected patients in the late-HAART era in developed countries
  • Author: Llibre, Josep M.;
    Revollo, Boris;
    Vanegas, Samuel;
    Lopez-Nuñez, Juan J.;
    Ornelas, Arelly;
    Marin, Joan M.;
    Santos, Jose R.;
    Marte, Paola;
    Morera, Marta;
    Zuluaga, Paola;
    Tor, Jordi;
    Clotet, Bonaventura
  • Found In: Scandinavian journal of infectious diseases. Volume 45:Number 8 (2013, August); pp 635-644
  • Journal Title: Scandinavian journal of infectious diseases
  • Subjects: Communicable diseases--Periodicals; Infection--Periodicals; Dewey: 616.9
  • Rights: legaldeposit
  • Publication Details: Informa Healthcare
  • Abstract: Abstract

    Background: In developed countries with free access to health care, primary chemoprophylaxis with co-trimoxazole, and antiretroviral treatment, Pneumocystis pneumonia (PCP) in HIV-infected subjects should be restricted to undiagnosed late presenters.

    Methods: We retrospectively identified confirmed PCP hospital admissions in HIV-1 patients (period 1986–2010) and examined their characteristics and factors associated with mortality.

    Results: Three hundred and twelve episodes (median CD4 27 cells/μl) were identified during 3 periods: pre-HAART (1986–1995), 49%; early-HAART (1996–1999), 17.3%; and late-HAART (2000–2010), 33.7%. PCP was the initial AIDS-defining diagnosis in only 86 (27.6%). Thirty-four (10.9%) patients died during their hospital stay, without a significant reduction in mortality in recent periods (p = 0.311). However, the 12-month mortality decreased through the periods (33.3% to 16.2%; p = 0.003). Drug users (p = 0.001) and those naïve to HAART (p < 0.001) decreased in the late-HAART era, while heterosexuals (p = 0.001), immigrants (p < 0.001), and HAART initiation before hospital discharge (p < 0.001) increased. A partial pressure of oxygen (PaO2) ≤ 55 (p = 0.04), intensive care admission (p < 0.001), and the absence of HAART initiation before discharge (p = 0.02) were correlated with mortality.

    Conclusions: The epidemiology and 12-month mortality of HIV-1-infected subjects with PCP have changed significantly in the late-HAART era, while mortality during hospital stay has remained unchanged. HIV diagnosed individuals lost to follow-up in care have emerged as the main driver of PCP in developed countries. Like HIV late presenters, they are more likely to have AIDS-defining illnesses, to be hospitalized, and to die. This finding has important implications for the design of better strategies to retain HIV-1-infected individuals in care.


  • Identifier: ETOClsidyv7c54f52e; System Number: LDEAvdc_100024482566.0x000001; Journal ISSN: 0036-5548; 10.3109/00365548.2013.777778
  • Publication Date: 2013
  • Physical Description: Electronic
  • Shelfmark(s): ELD Digital store

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