Rate of Pneumocystis pneumonia in Iranian HIV+ Patients with Pulmonary Infiltrates

Background: Pneumocystis jirovecii (formerly known as P. carinii) is one of the most opportunistic agents, which frequently leads to hospitalization and death in immunocompromised patients, especially in HIV-infected individuals. Objectives: The current study is the first report on the rate of the infection in Iranian HIV-infected individuals. Patients and Methods: We used two nested PCR and PCR-RFLP assays to amplify mt LSU rRNA and DHPS genes in 126 samples obtained from the respiratory systems of Iranian HIV-patients with CD4 count < 200 cells/μL, who were referred to two Research Centers from August 2010 to March 2011. Results: In the group of studied patients, 112 were male (88.9%). The mean age of the patients was 35.12 ± 9.75 years. Median CD4 T cell count of the patients was 93 cells/μL. Thirty nine patients (31%) were hospitalized, and 24 patients (18.9%) tested positive for Mycobacterium tuberculosis. In spite of receiving Pneumocystis pneumonia prophylaxis and highly active anti-retroviral therapy, P. jirovecii was detected in 15 samples (11.9%). Just one patient (0.8%) was co-infected with Mycobaterium tuberculosis. The mortality rate due to Pneumocystis pneumonia (PCP) was 26.6%. None of the isolates showed any mutation in codons 55 and 57, which are associated with resistance to sulfa/sulfon drugs. The sequencing results showed that the genetic patterns of Iranian isolates were similar to Indian and Spanish isolates (99% identity). Conclusions: The study indicated that the rate of P. jirovecii infection is similar to those reported from Asian, Indian and African countries. The similarity of the genetic pattern between Iranian and Indian isolates is probably due to their close geographical proximity.