Institute of Infection and Immunity, St George's Hospital and St George's University, London, UK.
Unité de Mycologie Moléculaire, Institut Pasteur, Paris, France.
Expert Rev Mol Diagn. 2024 Oct;24(10):899-911. doi: 10.1080/14737159.2024.2405920. Epub 2024 Nov 18.
While pneumonia (PcP) remains a major AIDS-defining disease, the majority of cases of PcP now present in the HIV-negative cohort, causing significant mortality. PcP PCR diagnosis is not novel, and the optimal route of diagnosis remains unclear, with an imperfect reference method and complexity in result interpretation for alternative tests.
This extensive review utilizing a literature search underpinning a recent systematic review/meta-analysis discusses the technical and clinical performance of PcP PCR, the added benefits of PCR testing, future aspects/considerations, and how PCR may be best used in clinical algorithms to provide a probability of PcP.
Given the current imperfect reference test for PcP, an alternative would be beneficial. Concerns over PcP PCR generating false positive results are valid but can be resolved by using positivity thresholds that drive specificity. Unfortunately, the extensive range of PCR assays complicates the provision of a PCR reference method. Combination testing incorporating PCR and B-D-Glucan, along with clinical and host risk factors, is key to understanding the individual probability of PcP. It is critical that access to PcP PCR testing is improved through technical and logistical development. Conversely, syndromic approaches including PcP need to be fully evaluated.
虽然肺炎（PcP）仍然是艾滋病的主要定义性疾病，但现在大多数 PcP 病例出现在 HIV 阴性人群中，导致了显著的死亡率。PcP PCR 诊断并不新颖，最佳诊断途径仍不清楚，参考方法并不完善，替代检测的结果解释也很复杂。
本综述广泛利用了一篇文献检索，为最近的系统综述/荟萃分析提供了支持，讨论了 PcP PCR 的技术和临床性能、PCR 检测的额外益处、未来的方面/考虑因素，以及如何在临床算法中最好地使用 PCR 来提供 PcP 的可能性。
鉴于目前用于 PcP 的参考检测并不完美，替代方法将是有益的。对 PcP PCR 产生假阳性结果的担忧是合理的，但可以通过使用驱动特异性的阳性阈值来解决。不幸的是，广泛的 PCR 检测方法使提供 PCR 参考方法变得复杂。结合 PCR 和 B-D-葡聚糖以及临床和宿主危险因素的联合检测，是了解个人 PcP 可能性的关键。通过技术和后勤发展来改善 PcP PCR 检测的获取至关重要。相反，需要对包括 PcP 在内的综合征方法进行全面评估。
