Limits...
Epidemiology and long-term survival in HIV-infected patients with Pneumocystis jirovecii pneumonia in the HAART era: experience in a university hospital and review of the literature.

López-Sánchez C, Falcó V, Burgos J, Navarro J, Martín MT, Curran A, Miguel L, Ocaña I, Ribera E, Crespo M, Almirante B - Medicine (Baltimore) (2015)

Bottom Line: During the study period, the incidence decreased significantly (from 13.4 cases/1000 patients-year to 3.3 cases/1000 patients-year, P < 0.001).Although the incidence has decreased, in-hospital mortality remains stable in this setting.Long-term survival is very high among HAART-adherent patients.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Infectious Diseases (CL-S, VF, JB, JN, AC, LM, IO, ER, MC, BA); and Department of Microbiology (MTM), University Hospital Valld'Hebron, UniversitatAutònoma de Barcelona, Barcelona, Spain.

ABSTRACT
As highly active antiretroviral treatment (HAART) is widely available, the incidence of Pneumocystis jirovecii pneumonia (PJP) has decreased significantly but still represents a significant cause of morbidity and mortality in developed countries. We analyzed all the cases with PJP in human immunodeficiency virus (HIV)-infected patients from 2000 to 2013 in a university hospital in Barcelona, Spain, and conducted a systematic literature review to evaluate data regarding incidence, mortality, and long-term survival after PJP in developed settings. One hundred thirty-six episodes of PJP were analyzed. During the study period, the incidence decreased significantly (from 13.4 cases/1000 patients-year to 3.3 cases/1000 patients-year, P < 0.001). Oppositely, median age of the patients increased from 34 years in 2000 to 45 in 2013 (P = 0.024). PJP preceded HIV diagnosis in nearly 50% of the cases. Fifteen (11%) patients died during the PJP episode. The main risk factor for in-hospital mortality in our cohort was age >50 years (odds ratio 4.96, 95% confidence interval [CI] 1.45-15.14). Patients who survived were followed-up during a mean time of 44 months. Overall 5-year survival of patients after hospital discharge was 73%. Survival likelihood was 54% higher (88% [95% CI 81-96]) among HAART-adherent patients. Mean age and the proportion of patients with unknown HIV infection at the time of PJP diagnosis have increased in developed countries in the HAART era. Although the incidence has decreased, in-hospital mortality remains stable in this setting. Long-term survival is very high among HAART-adherent patients.

Show MeSH

Related in: MedlinePlus

(A) Overall long-term survival of patients with PJP after hospital discharge and (B) long-term survival of patients with PJP after hospital discharge stratified by adherence to HAART. HAART = highly active antiretroviral treatment, PJP = Pneumocystis jirovecii pneumonia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4553998&req=5

Figure 2: (A) Overall long-term survival of patients with PJP after hospital discharge and (B) long-term survival of patients with PJP after hospital discharge stratified by adherence to HAART. HAART = highly active antiretroviral treatment, PJP = Pneumocystis jirovecii pneumonia.

Mentions: After a mean follow-up of 44 months after hospital discharge, 68% (92 out of 121 patients) survived. HAART initiation was offered to all of them, although only 111 (91.7%) of them accepted treatment initiation. Twenty (16%) patients died and 9 (7%) were lost to follow-up. Death was attributable to AIDS-related complications in 14 cases. The 5-year survival probability was 73% (95% CI 64.6–81.4) (Figure 2A). According to the definitions stated above, at 5-year follow-up, 91 (75.2%) patients presented good adherence to HAART and 30 (24.8%) patients presented bad adherence to HAART. Poor adherence to HAART was significantly associated with lower 5-year survival (Figure 2B). In the multivariate analysis, the only factor associated with bad adherence to HAART was intravenous drug use (IVDU) as risk factor for HIV infection (OR 5.87, 95% CI 2.2–15.6).


Epidemiology and long-term survival in HIV-infected patients with Pneumocystis jirovecii pneumonia in the HAART era: experience in a university hospital and review of the literature.

López-Sánchez C, Falcó V, Burgos J, Navarro J, Martín MT, Curran A, Miguel L, Ocaña I, Ribera E, Crespo M, Almirante B - Medicine (Baltimore) (2015)

(A) Overall long-term survival of patients with PJP after hospital discharge and (B) long-term survival of patients with PJP after hospital discharge stratified by adherence to HAART. HAART = highly active antiretroviral treatment, PJP = Pneumocystis jirovecii pneumonia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553998&req=5

Figure 2: (A) Overall long-term survival of patients with PJP after hospital discharge and (B) long-term survival of patients with PJP after hospital discharge stratified by adherence to HAART. HAART = highly active antiretroviral treatment, PJP = Pneumocystis jirovecii pneumonia.
Mentions: After a mean follow-up of 44 months after hospital discharge, 68% (92 out of 121 patients) survived. HAART initiation was offered to all of them, although only 111 (91.7%) of them accepted treatment initiation. Twenty (16%) patients died and 9 (7%) were lost to follow-up. Death was attributable to AIDS-related complications in 14 cases. The 5-year survival probability was 73% (95% CI 64.6–81.4) (Figure 2A). According to the definitions stated above, at 5-year follow-up, 91 (75.2%) patients presented good adherence to HAART and 30 (24.8%) patients presented bad adherence to HAART. Poor adherence to HAART was significantly associated with lower 5-year survival (Figure 2B). In the multivariate analysis, the only factor associated with bad adherence to HAART was intravenous drug use (IVDU) as risk factor for HIV infection (OR 5.87, 95% CI 2.2–15.6).

Bottom Line: During the study period, the incidence decreased significantly (from 13.4 cases/1000 patients-year to 3.3 cases/1000 patients-year, P < 0.001).Although the incidence has decreased, in-hospital mortality remains stable in this setting.Long-term survival is very high among HAART-adherent patients.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Infectious Diseases (CL-S, VF, JB, JN, AC, LM, IO, ER, MC, BA); and Department of Microbiology (MTM), University Hospital Valld'Hebron, UniversitatAutònoma de Barcelona, Barcelona, Spain.

ABSTRACT
As highly active antiretroviral treatment (HAART) is widely available, the incidence of Pneumocystis jirovecii pneumonia (PJP) has decreased significantly but still represents a significant cause of morbidity and mortality in developed countries. We analyzed all the cases with PJP in human immunodeficiency virus (HIV)-infected patients from 2000 to 2013 in a university hospital in Barcelona, Spain, and conducted a systematic literature review to evaluate data regarding incidence, mortality, and long-term survival after PJP in developed settings. One hundred thirty-six episodes of PJP were analyzed. During the study period, the incidence decreased significantly (from 13.4 cases/1000 patients-year to 3.3 cases/1000 patients-year, P < 0.001). Oppositely, median age of the patients increased from 34 years in 2000 to 45 in 2013 (P = 0.024). PJP preceded HIV diagnosis in nearly 50% of the cases. Fifteen (11%) patients died during the PJP episode. The main risk factor for in-hospital mortality in our cohort was age >50 years (odds ratio 4.96, 95% confidence interval [CI] 1.45-15.14). Patients who survived were followed-up during a mean time of 44 months. Overall 5-year survival of patients after hospital discharge was 73%. Survival likelihood was 54% higher (88% [95% CI 81-96]) among HAART-adherent patients. Mean age and the proportion of patients with unknown HIV infection at the time of PJP diagnosis have increased in developed countries in the HAART era. Although the incidence has decreased, in-hospital mortality remains stable in this setting. Long-term survival is very high among HAART-adherent patients.

Show MeSH
Related in: MedlinePlus