HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Pneumocystis jirovecii pneumonia in Spanish HIV-infected patients in the combined antiretroviral therapy era: prevalence of dihydropteroate synthase mutations and prognostic factors of mortality.

Abstract
The incidence of Pneumocystis jirovecii pneumonia (PCP) in HIV-infected patients has decreased thanks to sulfa prophylaxis and combined antiretroviral therapy. The influence of P. jirovecii dihydropteroate synthase (DHPS) gene mutations on survival is controversial and has not been reported in Spain. This prospective multicenter study enrolled 207 HIV-infected patients with PCP from 2000 to 2004. Molecular genotyping was performed on stored specimens. Risk factors for intensive care unit (ICU) admission and mortality were identified using a logistic regression model. Seven patients (3.7%; 95% confidence interval [CI], 1.5-7.5%) had DHPS mutations. Overall mortality was 15% (95% CI, 10-21%), rising to 80% (95% CI, 61-92%) in patients requiring mechanical ventilation. None of the patients with DHPS mutants died, nor did they need ICU admission or mechanical ventilation. PaO(2) <60 mm Hg at admission was a predictor of ICU admission (P = 0.01), and previous antiretroviral therapy predicted non-ICU admission (P = 0.009). PaO(2) <60 mm Hg at admission and ICU admission during the 1st week were predictors of mortality (P = 0.03 and P < 0.001, respectively). The prevalence of DHPS mutants in Spain is low and is not associated with a worse outcome. Severe respiratory failure at admission is the strongest predictor of PCP outcome.
AuthorsMíriam J Alvarez-Martínez, Asunción Moreno, José M Miró, Maria Eugenia Valls, Paula V Rivas, Elisa de Lazzari, Omar Sued, Natividad Benito, Pere Domingo, Esteban Ribera, Miguel Santín, Guillermo Sirera, Ferràn Segura, Francesc Vidal, Francisco Rodríguez, Melchor Riera, Maria Elisa Cordero, José Ramón Arribas, Maria Teresa Jiménez de Anta, José M Gatell, Paul E Wilson, Steven R Meshnick, Spanish PCP Working Group
JournalDiagnostic microbiology and infectious disease (Diagn Microbiol Infect Dis) Vol. 62 Issue 1 Pg. 34-43 (Sep 2008) ISSN: 0732-8893 [Print] United States
PMID18554841 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • Dihydropteroate Synthase
Topics
  • AIDS-Related Opportunistic Infections (microbiology, mortality)
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Dihydropteroate Synthase (genetics)
  • Female
  • HIV Infections (complications, drug therapy, genetics, mortality)
  • HIV-1 (drug effects)
  • Humans
  • Male
  • Middle Aged
  • Mutation
  • Pneumocystis carinii (enzymology, genetics)
  • Pneumonia, Pneumocystis (complications, microbiology, mortality)
  • Prevalence
  • Prognosis
  • Risk Factors
  • Spain (epidemiology)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: