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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.

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Related in: MedlinePlus

Flow chart of search strategy for article selection. ICU = intensive care unit.
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Figure 3: Flow chart of search strategy for article selection. ICU = intensive care unit.

Mentions: Initially, 723 articles were identified and screened through PubMed database. By title and abstract review, 660 articles were excluded on the grounds of being single-case reports, reviews, or guidelines, or having a focus other than HIV-infected patients. From the remaining 63 studies, 45 were excluded for additional causes after full-text reading (Figure 3). The key studies addressing PJP in the developed world are summarized in Table 4.


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)

Flow chart of search strategy for article selection. ICU = intensive care unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Flow chart of search strategy for article selection. ICU = intensive care unit.
Mentions: Initially, 723 articles were identified and screened through PubMed database. By title and abstract review, 660 articles were excluded on the grounds of being single-case reports, reviews, or guidelines, or having a focus other than HIV-infected patients. From the remaining 63 studies, 45 were excluded for additional causes after full-text reading (Figure 3). The key studies addressing PJP in the developed world are summarized in Table 4.

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