BACKGROUND: pneumonia (PJP) is increasingly recognized among immunocompromised adults without HIV, yet prophylaxis use remains inconsistent. Data describing cumulative and overlapping immunosuppressive exposures before PJP diagnosis are limited. OBJECTIVE: To characterize immunosuppressive exposure patterns and evaluate use of PJP-active therapy among non-HIV, nonhematopoietic cell transplant (non-HCT) adults with PJP. METHODS: This retrospective cohort study (2011-2024) used the TriNetX Research Network. Adults without HIV or prior HCT with laboratory-confirmed PJP (positive polymerase chain reaction or antigen from respiratory specimens) were included. Demographics, comorbidities, and exposure to glucocorticoids (GCs), antineoplastics (ANs), and immunosuppressants (ISs) within 90 days before diagnosis were assessed. Overlapping immunosuppressive regimens and their associations with receipt of PJP-active therapy were evaluated. Because prescribing indication and dosing were unavailable, prescriptions for trimethoprim/sulfamethoxazole, atovaquone, dapsone, or pentamidine were grouped as PJP-active therapy, representing prophylactic, preemptive, or empiric use. RESULTS: < 0.001), while AN and IS exposures did not differ between groups. CONCLUSION AND RELEVANCE: PJP in non-HIV, non-HCT adults commonly occurs in the setting of frequent multidrug immunosuppression. These findings reveal a disconnect between cumulative immunosuppressive risk and prophylaxis practices and support approaches that incorporate overall immunologic burden rather than single-agent thresholds.
Chastain et al. (Sun,) studied this question.
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