HIV-associated Pneumocystis pneumonia

Proc Am Thorac Soc. 2011 Jun;8(3):294-300. doi: 10.1513/pats.201009-062WR.


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).

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis*
  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / therapy*
  • AIDS-Related Opportunistic Infections / transmission
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Infective Agents / therapeutic use
  • Biomarkers / blood
  • Bronchoalveolar Lavage
  • Bronchoscopy
  • CD4 Lymphocyte Count
  • Dihydropteroate Synthase / genetics
  • Drug Resistance, Fungal
  • HIV Infections / epidemiology*
  • Humans
  • Mutation
  • Pneumocystis carinii / genetics
  • Pneumonia, Pneumocystis / diagnosis*
  • Pneumonia, Pneumocystis / epidemiology
  • Pneumonia, Pneumocystis / therapy*
  • Pneumonia, Pneumocystis / transmission
  • Pneumothorax / etiology
  • Polymerase Chain Reaction
  • Primary Prevention
  • Radiography, Thoracic
  • S-Adenosylmethionine / blood
  • Secondary Prevention
  • Tetrahydrofolate Dehydrogenase / genetics
  • Tomography, X-Ray Computed
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • beta-Glucans / blood


  • Adrenal Cortex Hormones
  • Anti-Infective Agents
  • Biomarkers
  • beta-Glucans
  • S-Adenosylmethionine
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Tetrahydrofolate Dehydrogenase
  • Dihydropteroate Synthase