Coinfection of Pneumocystis jirovecii with Cytomegalovirus Pneumonia and Pulmonary Tuberculosis among Human Immunodeficiency Virus Patients at a Referral Hospital in Tehran.

BACKGROUND

Pneumocystis jirovecii pneumonia (PJP) is still a common opportunistic infection among patients with human immunodeficiency virus (HIV) infection, which has significant mortality if not diagnosed and treated in time.

METHODS

This study identified and compared demographic, clinical, and radiological characteristics between individuals with solitary PJP and those with concurrent pulmonary infections with other agents.

RESULTS

The medical records of 1040 HIV-positive patients with pulmonary diseases were analyzed, and 140 cases of PJP pneumonia were selected. The average age was 37.2 ± 9.2 years, 72% were male, and 52% were intravenous drug users. Most patients had low CD4+ cell counts (median: 25 cells/mm3), were new cases (65%), and antiretroviral drug-naïve (82%). Among confirmed PJP cases, 25.9% had concurrent infections, mainly tuberculosis (TB; 8 cases) and cytomegalovirus pneumonia (8 cases). The comparison showed that there were no significant differences between the two groups in terms of age, gender, history of antiretroviral treatment, history of PJP, history of TB, erythrocyte sedimentation rate, CD4 count, HIV viral load, and the pattern of lung involvement in computed tomography scan imaging. The mortality rates were 17.2% for patients solely infected with PJP and 44.7% for those with coinfections (P < 0.001).

CONCLUSIONS

These results suggest that diagnosing coinfection of PJP and other pulmonary infections is essential, given the higher mortality.