Pneumocystis jirovecii pneumonia (PJP) is the most frequent and severe respiratory infection in patients with acquired immunodeficiency syndrome (AIDS) with associated 20% mortality. There have been conflicting data regarding the optimal time to initiate antiretroviral therapy (ART) in these patients with most data suggesting benefit for early initiation. The objectives of this study were to compare patients with PJP and AIDS who were initiated on ART while hospitalized compared to those who were not; and to evaluate the association between inpatient initiation of ART and survival.
We conducted a retrospective chart review of patients 18 years or older with PJP and AIDS who were not on ART prior to admission. We collected demographic, laboratory and clinical information. SPSS was used to compare the two groups: those who initiated ART while inpatient (ART) vs. those who did not (NoART)
Of the 64 patients included in this study, 25 [39%] were in the ART group, 19 [27%] required intensive care unit (ICU), and 16 [25%] required mechanical ventilation (MV). There were no differences in age, gender, race/ethnicity, and smoking between the ART and NoART groups. A higher percentage of patients in the ART group received corticosteroids (96% vs 72%; p=0.020), required MV (48% vs.10%; p=0.001), and ICU admission (60% vs. 10%; p=0.000) than in the NoART group respectively. There were no differences in the ART and NoART groups in regards to ICU stay (4 vs 0.5 days; P = 1.000) and APACHE II scores (15.2 vs 10.7; P = 0.17). A total of 9 (14%) patients died while in the hospital 6 (24%) in ART vs. 3 (8%) in NoART (p=0.137).
Patients with PJP pneumonia who were initiated on ART while inpatient were more likely to require ICU admission, corticosteroids, and mechanical ventilation. There were no differences in APACHE II scores, CD4 count and mortality between those who initiated ART while inpatients vs. those who did not. Further studies with larger sample size are needed to evaluate the association between inpatient initiation of ART and survival.
N. Fadul, None