Pneumocystis jirovecii pneumonia in patients with and without HIV infection: A multicentre comparative study

OBJECTIVES: To compare the clinical presentation, management and outcomes of microbiologically confirmed Pneumocystis jirovecii pneumonia (PJP) in patients with and without HIV infection. METHODS: We conducted a multicentre retrospective study of adults admitted to three tertiary hospitals. Patients were stratified by HIV status, and only microbiologically confirmed PJP cases were included. Clinical, radiological, treatment and outcome data were analysed. Multivariable logistic regression identified factors associated with PJP-related mortality and, exploratorily, intensive care unit (ICU) admission. RESULTS: Over the 13-year study period, the estimated incidence was 1.40 cases per 100,000 person-years in a catchment population of approximately 780,000 inhabitants. A total of 142 patients were included. Most were HIV-negative (60.6%) and older than those with HIV. Non-HIV patients more often had atypical imaging and required oxygen therapy, whereas ICU admission was more frequent among HIV-positive patients. PJP-related mortality was 10.6%, with no differences by HIV status. In multivariable analysis, ICU admission was independently associated with lower PJP-related mortality (aOR 0.26, 95% confidence interval [CI] 0.07-0.91), while age and HIV status were not. HIV-negative status was independently associated with a lower likelihood of ICU admission compared with PLWH (aOR 0.29, 95% CI 0.11-0.82). CONCLUSION: PJP predominantly affects non-HIV immunocompromised patients. Mortality remains substantial but is not independently associated with HIV status. The association between ICU admission and mortality likely reflects selection and survivorship bias, highlighting the need for improved prophylaxis and diagnostic vigilance.