HIV-associated Pneumocystis pneumonia.

Laurence Huang, Adithya Cattamanchi, J Lucian Davis, Saskia den Boon, Joseph Kovacs, Steven Meshnick, Robert F Miller, Peter D Walzer, William Worodria, Henry Masur

Journal: Proceedings of the American Thoracic Society 2011;8(3):294-300

PMID: 21653531

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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).

Address: Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California 94110, USA. [email protected]

DOI: 10.1513/pats.201009-062WR

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MeSH Terms: AIDS-Related Opportunistic Infections, Adrenal Cortex Hormones, Anti-Infective Agents, Biomarkers, Bronchoalveolar Lavage, Bronchoscopy, CD4 Lymphocyte Count, Dihydropteroate Synthase, Drug Resistance, Fungal, HIV Infections, Humans, Mutation, Pneumocystis carinii, Pneumonia, Pneumocystis, Pneumothorax, Polymerase Chain Reaction, Primary Prevention, Radiography, Thoracic, S-Adenosylmethionine, Secondary Prevention, Tetrahydrofolate Dehydrogenase, Tomography, X-Ray Computed, Trimethoprim, Sulfamethoxazole Drug Combination, beta-Glucans