Pneumocystis jirovecii pneumonia in HIV-1-infected patients in the late-HAART era in developed countries.

AbstractBackground: In developed countries with free access to health care, primary chemoprophylaxis with co-trimoxazole, and antiretroviral treatment, Pneumocystis pneumonia (PCP) in HIV-infected subjects should be restricted to undiagnosed late presenters.Methods: We retrospectively identified confirmed PCP hospital admissions in HIV-1 patients (period 1986–2010) and examined their characteristics and factors associated with mortality.Results: Three hundred and twelve episodes (median CD4 27 cells/μl) were identified during 3 periods: pre-HAART (1986–1995), 49%; early-HAART (1996–1999), 17.3%; and late-HAART (2000–2010), 33.7%. PCP was the initial AIDS-defining diagnosis in only 86 (27.6%). Thirty-four (10.9%) patients died during their hospital stay, without a significant reduction in mortality in recent periods (p = 0.311). However, the 12-month mortality decreased through the periods (33.3% to 16.2%; p = 0.003). Drug users (p = 0.001) and those naive to HAART (p < 0.001) decreased in the late-HAART e...