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. 2025 Dec 10:thorax-2025-223504.
doi: 10.1136/thorax-2025-223504. Online ahead of print.

Prognostic impact and safety of early adjunctive corticosteroid therapy in HIV-negative severe pneumocystis pneumonia: a propensity-matched multicentre study

Florian Reizine  1 , Vicky Stiegler  2 , Romain Lecuyer  2 , Benoit Tessoulin  3 , Guillaume Rieul  4 , Fabrice Camou  5 , Florent Morio  6 , Anne Cady  7 , Frederic Gabriel  8 , Emmanuel Canet  9 , François Raffi  2 , David Boutoille  2 , Nahéma Issa  10 , Benjamin Jean Gaborit  2   11 ; pronocystis study group
Collaborators, Affiliations

Prognostic impact and safety of early adjunctive corticosteroid therapy in HIV-negative severe pneumocystis pneumonia: a propensity-matched multicentre study

Florian Reizine et al. Thorax. .

Abstract

Background: Pneumocystis jirovecii pneumonia (PcP) in HIV-negative patients is associated with high mortality rates. While early adjunctive corticosteroid (AC) therapy benefits HIV-positive patients with severe PcP, its efficacy and safety in HIV-negative patients remain poorly investigated.

Methods: This multicentre retrospective observational study included consecutive patients diagnosed with proven or probable PcP, from January 2011 to January 2021. This study assessed the prognostic impact and safety of early AC in HIV-negative patients with PcP. To address baseline characteristic imbalances between patients, a non-parsimonious propensity matching analysis was performed with a 1/1 ratio. Survival analysis, day-90 mortality rate and healthcare-associated infections (HCAI) were compared using Cox and logistic regressions.

Results: 350 consecutive HIV-negative patients with proven or probable PcP were included. Of these, 116 (33.1%) received early AC within 5 days of anti-PcP therapy initiation. The median arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio was 224 (114-229). The 90-day mortality rate was 29.4% (103/350). There was no significant difference in 90-day mortality according to AC, both in overall and matched populations (OR 1.27 (0.78-2.05); p=0.336 and 0.92 (0.52-1.62); p=0.772, respectively). HCAI incidences appeared similar between groups. In the matched population, a higher proportion of AC patients required high-flow oxygen therapy (OR 2.15 (1.17-4.05); p=0.015) and mechanical ventilation duration was higher in corticosteroid recipients (OR 1.04 (1.01-1.09); p=0.048).

Conclusion: Early AC therapy was not associated with reduced 90-day mortality in HIV-negative PcP patients. Although recommended in hypoxemic HIV-positive PcP patients, the benefit of this strategy in HIV-negative patients remains to be proven.

Keywords: Critical Care; Hypoxemia; Immunodeficiency; Pneumonia; Respiratory Infection.

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Conflict of interest statement

Competing interests: BJG reports receipt of non-financial support from Gilead Sciences, MSD and Pfizer, outside the submitted work. FRa reports receipt of personal fees from Abbvie, AstraZeneca, Gilead Sciences, Janssen, Merck, Roche and ViiV Healthcare, outside the submitted work. EC reports personal fees from Gilead, Sanofi-Genzyme and Baxter, outside the submitted work. None declared (FRe, VS, RL, NI, GR, FC, FG, FM, DB, AC, BT).

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