Møller Anne K, Schnoor Stine B, Petersen Inge, Martin-Iguacel Raquel, Kronborg Gitte, Larsen Carsten S, Dalager-Pedersen Michael, Gerstoft Jan, Omland Lars H, Rasmussen Line D
Department of Infectious Disease, Odense University Hospital, Odense, Denmark.
Research Unit of Infectious Diseases, University of Southern Denmark, Odense, Denmark.
Open Forum Infect Dis. 2025 May 14;12(6):ofaf289. doi: 10.1093/ofid/ofaf289. eCollection 2025 Jun.
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.
我们旨在研究人类免疫缺陷病毒（HIV）感染者的肺孢子菌肺炎（PCP）风险和死亡率，以及与以下因素的关联：（1）HIV诊断后的时间；（2）日历时间；（3）CD4细胞计数。
从丹麦HIV队列研究中，我们确定了所有成年HIV感染者（PWH）（1995 - 2021年）。我们估计了发病率（IRs）和死亡率。我们使用泊松回归分析来计算调整后的发病率比（IRRs）和死亡率比。根据HIV诊断后的时间、日历时间和低CD4细胞计数评估PCP风险。
在4882名PWH（53647人年）中，我们观察到336例PCP事件（与1995 - 1999年相比，2016 - 2021年期间，HIV诊断后的第一年PCP风险降低了90%以上；调整后的发病率比[aIRR]，0.08[95%置信区间{CI}，0.02 - 0.29]，如果基线CD4计数<200个细胞/微升，第一年降低了40%以上[aIRR，0.57[95%CI，0.36 - 0.90]]。然而，对于后一组，1995 - 1999年后未观察到PCP风险有统计学显著变化。如果在联合抗逆转录病毒治疗（cART）的第一年CD4计数为100至<200个细胞/微升（发病率，16.08[95%CI，5.19 - 49.89]），尽管病毒载量得到抑制，PCP风险仍然很高。在cART治疗1年后（CD4计数为100至<200个细胞/微升）发现有大幅降低。尽管不显著，但从1995 - 1999年到2016 - 2021年，3个月和12个月的死亡率下降了80%。
PCP在晚期HIV感染者中仍然是一个重大问题，强调了早期HIV诊断的重要性。应考虑持续进行PCP预防，直到CD4计数>100个细胞/微升，进行至少1年的cART且病毒抑制超过3个月；然而，需要进一步研究来证实这些结果。
