Pneumocystis Pneumonia—Is it Still a Threat Among People With Human Immunodeficiency Virus (HIV)? A Danish HIV Cohort Study
We aimed to examine pneumocystis pneumonia (PCP) risk and mortality among people with human immunodeficiency virus (HIV), and associations with (1) time after HIV diagnosis, (2) calendar time, and (3) CD4 cell count. From the Danish HIV cohort study, we identified all adult people with HIV (PWH) (19...
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| Vydáno v: | Open forum infectious diseases Ročník 12; číslo 6; s. ofaf289 |
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01.06.2025
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| Abstract | We aimed to examine pneumocystis pneumonia (PCP) risk and mortality among people with human immunodeficiency virus (HIV), and associations with (1) time after HIV diagnosis, (2) calendar time, and (3) CD4 cell count.
From the Danish HIV cohort study, we identified all adult people with HIV (PWH) (1995-2021). We estimated incidence rates (IRs) and mortality rates. We used Poisson regression analysis to compute adjusted incidence ratios (IRRs) and mortality rate ratios. PCP risk was assessed according to time after HIV diagnosis, calendar time, and low CD4 cell count.
Among 4882 PWH (53 647 person-years), we observed 336 PCP events (for the time period 2016-2021 compared to 1995-1999, PCP risk decreased by >90% after the first year of HIV diagnosis; aIRR, 0.08 [95% confidence interval {CI}, .02-.29], and by >40% in the first year, if baseline CD4 count was <200 cells/µL [aIRR, 0.57 [95% CI, .36-.90]). However, no statistically significant change in PCP risk was observed after 1995-1999 for the latter group. PCP risk remained high if the CD4 count was 100 to <200 cells/µL (IR, 16.08 [95% CI, 5.19-49.89]) during the first year of combination antiretroviral therapy (cART), despite a suppressed viral load. Major reductions were found after 1 year of cART (CD4 count 100 to <200 cells/µL). Although nonsignificant, the 3- and 12-month mortality rate decreased by 80% from 1995-1999 to 2016-2021.
PCP remains a significant problem among late presenters with HIV, emphasizing the importance of early HIV diagnosis. Continuing PCP prophylaxis until the CD4 count is >100 cells/µL, with at least 1 year of cART and viral suppression for >3 months should be considered; however; further studies are needed to confirm these results. |
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| AbstractList | This nationwide, population-based cohort study found that pneumocystis pneumonia (PCP) remain a substantial problem among late presenters with HIV. Furthermore, continuing PCP prophylaxis until the CD4 count is >100 cells/µL, ≥1 year of combination antiretroviral therapy, and viral suppression >3 months should be considered. We aimed to examine pneumocystis pneumonia (PCP) risk and mortality among people with human immunodeficiency virus (HIV), and associations with (1) time after HIV diagnosis, (2) calendar time, and (3) CD4 cell count.BackgroundWe aimed to examine pneumocystis pneumonia (PCP) risk and mortality among people with human immunodeficiency virus (HIV), and associations with (1) time after HIV diagnosis, (2) calendar time, and (3) CD4 cell count.From the Danish HIV cohort study, we identified all adult people with HIV (PWH) (1995-2021). We estimated incidence rates (IRs) and mortality rates. We used Poisson regression analysis to compute adjusted incidence ratios (IRRs) and mortality rate ratios. PCP risk was assessed according to time after HIV diagnosis, calendar time, and low CD4 cell count.MethodsFrom the Danish HIV cohort study, we identified all adult people with HIV (PWH) (1995-2021). We estimated incidence rates (IRs) and mortality rates. We used Poisson regression analysis to compute adjusted incidence ratios (IRRs) and mortality rate ratios. PCP risk was assessed according to time after HIV diagnosis, calendar time, and low CD4 cell count.Among 4882 PWH (53 647 person-years), we observed 336 PCP events (for the time period 2016-2021 compared to 1995-1999, PCP risk decreased by >90% after the first year of HIV diagnosis; aIRR, 0.08 [95% confidence interval {CI}, .02-.29], and by >40% in the first year, if baseline CD4 count was <200 cells/µL [aIRR, 0.57 [95% CI, .36-.90]). However, no statistically significant change in PCP risk was observed after 1995-1999 for the latter group. PCP risk remained high if the CD4 count was 100 to <200 cells/µL (IR, 16.08 [95% CI, 5.19-49.89]) during the first year of combination antiretroviral therapy (cART), despite a suppressed viral load. Major reductions were found after 1 year of cART (CD4 count 100 to <200 cells/µL). Although nonsignificant, the 3- and 12-month mortality rate decreased by 80% from 1995-1999 to 2016-2021.ResultsAmong 4882 PWH (53 647 person-years), we observed 336 PCP events (for the time period 2016-2021 compared to 1995-1999, PCP risk decreased by >90% after the first year of HIV diagnosis; aIRR, 0.08 [95% confidence interval {CI}, .02-.29], and by >40% in the first year, if baseline CD4 count was <200 cells/µL [aIRR, 0.57 [95% CI, .36-.90]). However, no statistically significant change in PCP risk was observed after 1995-1999 for the latter group. PCP risk remained high if the CD4 count was 100 to <200 cells/µL (IR, 16.08 [95% CI, 5.19-49.89]) during the first year of combination antiretroviral therapy (cART), despite a suppressed viral load. Major reductions were found after 1 year of cART (CD4 count 100 to <200 cells/µL). Although nonsignificant, the 3- and 12-month mortality rate decreased by 80% from 1995-1999 to 2016-2021.PCP remains a significant problem among late presenters with HIV, emphasizing the importance of early HIV diagnosis. Continuing PCP prophylaxis until the CD4 count is >100 cells/µL, with at least 1 year of cART and viral suppression for >3 months should be considered; however; further studies are needed to confirm these results.ConclusionsPCP remains a significant problem among late presenters with HIV, emphasizing the importance of early HIV diagnosis. Continuing PCP prophylaxis until the CD4 count is >100 cells/µL, with at least 1 year of cART and viral suppression for >3 months should be considered; however; further studies are needed to confirm these results. We aimed to examine pneumocystis pneumonia (PCP) risk and mortality among people with human immunodeficiency virus (HIV), and associations with (1) time after HIV diagnosis, (2) calendar time, and (3) CD4 cell count. From the Danish HIV cohort study, we identified all adult people with HIV (PWH) (1995-2021). We estimated incidence rates (IRs) and mortality rates. We used Poisson regression analysis to compute adjusted incidence ratios (IRRs) and mortality rate ratios. PCP risk was assessed according to time after HIV diagnosis, calendar time, and low CD4 cell count. Among 4882 PWH (53 647 person-years), we observed 336 PCP events (for the time period 2016-2021 compared to 1995-1999, PCP risk decreased by >90% after the first year of HIV diagnosis; aIRR, 0.08 [95% confidence interval {CI}, .02-.29], and by >40% in the first year, if baseline CD4 count was <200 cells/µL [aIRR, 0.57 [95% CI, .36-.90]). However, no statistically significant change in PCP risk was observed after 1995-1999 for the latter group. PCP risk remained high if the CD4 count was 100 to <200 cells/µL (IR, 16.08 [95% CI, 5.19-49.89]) during the first year of combination antiretroviral therapy (cART), despite a suppressed viral load. Major reductions were found after 1 year of cART (CD4 count 100 to <200 cells/µL). Although nonsignificant, the 3- and 12-month mortality rate decreased by 80% from 1995-1999 to 2016-2021. PCP remains a significant problem among late presenters with HIV, emphasizing the importance of early HIV diagnosis. Continuing PCP prophylaxis until the CD4 count is >100 cells/µL, with at least 1 year of cART and viral suppression for >3 months should be considered; however; further studies are needed to confirm these results. |
| Author | Møller, Anne K Larsen, Carsten S Rasmussen, Line D Martin-Iguacel, Raquel Dalager-Pedersen, Michael Kronborg, Gitte Schnoor, Stine B Gerstoft, Jan Petersen, Inge Omland, Lars H |
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| Cites_doi | 10.1111/hiv.12878 10.1086/655761 10.1016/S1473-3099(17)30303-1 10.2807/1560-7917.ES.2019.24.41.1900225 10.1093/cid/ciaa615 10.1097/MD.0000000000000681 10.1016/j.eclinm.2021.100877 10.1093/infdis/jiw085 10.1111/j.1365-2125.2011.03935.x 10.1080/14787210.2019.1671823 10.1111/hiv.12735 10.1093/aje/kwq433 10.1093/ije/dyu153 10.1177/1060028016650107 10.1056/NEJMoa1506816 10.1177/1403494810387965 10.1097/QAD.0000000000001085 10.1016/S0140-6736(08)61113-7 10.1080/14787210.2017.1364991 10.7326/L16-0091 |
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| Keywords | AIDS HIV PCP cART Pneumocystis jirovecii |
| Language | English |
| License | https://creativecommons.org/licenses/by-nc-nd/4.0 The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Potential conflicts of interest. All authors: No reported conflicts. A. K. M. and S. B. S. contributed equally to this work as joint first authors. |
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| Title | Pneumocystis Pneumonia—Is it Still a Threat Among People With Human Immunodeficiency Virus (HIV)? A Danish HIV Cohort Study |
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