HIV-associated Pneumocystis pneumonia

Abstract

During the past 30 years, major advances have been made in our understanding of HIV/AIDS and Pneumocystis pneumonia (PCP), but significant gaps remain. Pneumocystis is classified as a fungus and is host-species specific, but an understanding of its reservoir, mode of transmission, and pathogenesis is incomplete. PCP remains a frequent AIDS-defining diagnosis and is a frequent opportunistic pneumonia in the United States and in Europe, but comparable epidemiologic data from other areas of the world that are burdened with HIV/AIDS are limited. Pneumocystis cannot be cultured, and bronchoscopy with bronchoalveolar lavage is the gold standard procedure to diagnose PCP, but noninvasive diagnostic tests and biomarkers show promise that must be validated. Trimethoprim-sulfamethoxazole is the recommended first-line treatment and prophylaxis regimen, but putative trimethoprim-sulfamethoxazole drug resistance is an emerging concern. The International HIV-associated Opportunistic Pneumonias (IHOP) study was established to address these knowledge gaps. This review describes recent advances in the pathogenesis, epidemiology, diagnosis, and management of HIV-associated PCP and ongoing areas of clinical and translational research that are part of the IHOP study and the Longitudinal Studies of HIV-associated Lung Infections and Complications (Lung HIV).

Figure 1.

Annual number of microscopically confirmed cases of Pneumocystis pneumonia (PCP) diagnosed at San Francisco General Hospital, 1990–2009. ART = antiretroviral therapy.

Figure 2.

Chest radiograph demonstrating the characteristic bilateral, symmetric granular opacities in an HIV-infected patient with Pneumocystis pneumonia (courtesy of L. Huang, used with permission).

Figure 3.

Chest high-resolution computed tomograph demonstrating the characteristic ground glass opacities in an HIV-infected patient with Pneumocystis pneumonia who had a normal chest radiograph (courtesy of L. Huang, used with permission).