Lower Mortality Associated With Adjuvant Corticosteroid Therapy in Non-HIV-Infected Patients With Pneumocystis jirovecii Pneumonia: A Single-Institution Retrospective US Cohort Study

William Mundo; Louis Morales-Shnaider; Selam Tewahade; Eric Wagner; Solana Archuleta; Mohamed Bandali; Sindhu Chadalawada; Steven C Johnson; Carlos Franco-Paredes; Leland Shapiro; Andrés F Henao-Martínez

doi:10.1093/ofid/ofaa354

Lower Mortality Associated With Adjuvant Corticosteroid Therapy in Non-HIV-Infected Patients With Pneumocystis jirovecii Pneumonia: A Single-Institution Retrospective US Cohort Study

Open Forum Infect Dis. 2020 Aug 13;7(9):ofaa354. doi: 10.1093/ofid/ofaa354. eCollection 2020 Sep.

Authors

William Mundo^{1

2}, Louis Morales-Shnaider³, Selam Tewahade², Eric Wagner¹, Solana Archuleta¹, Mohamed Bandali¹, Sindhu Chadalawada⁴, Steven C Johnson⁴, Carlos Franco-Paredes^{1

5

6}, Leland Shapiro^{5

7

8}, Andrés F Henao-Martínez^{1

5}

Affiliations

¹ School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³ Graduate School, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁴ Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁵ NRI Medical College, NRI General Hospital, Guntur, Andhra Pradesh, India.
⁶ Hospital Infantil de México, Federico Gómez, México City, México.
⁷ Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.
⁸ The Emily Foundation for Medical Research, Boston, Massachusetts, USA.

Abstract

Background: Pneumocystis jirovecii pneumonia (PJP) remains a cause of mortality in HIV-negative patients. The clinical benefit of adjuvant corticosteroids in these patients is uncertain. This study aimed to determine if corticosteroids would reduce mortality in a cohort of HIV-negative PJP patients.

Methods: We examined a retrospective case series of patients diagnosed with PJP at the University of Colorado Hospital between 1995 and 2019. Data were collected in 71 PJP-infected patients. Twenty-eight patients were HIV-negative, and 43 were infected with HIV. We performed bivariate and forward, stepwise multivariable logistic regressions to identify mortality predictors.

Results: Common underlying conditions in HIV-negative patients were hematologic malignancies (28.6%), autoimmune disorders (25.9%), and solid organ transplantation (10.7%). HIV-negative patients had higher rates and durations of mechanical ventilation and intensive care unit stay. Survival was significantly increased in HIV-negative patients receiving adjuvant corticosteroids, with 100% mortality in patients not receiving corticosteroids vs 60% mortality in patients receiving corticosteroids (P = .034). In an adjusted multivariable model, no adjuvant corticosteroid use was associated with higher mortality (odds ratio, 13.5; 95% CI, 1.1-158.5; P = .039) regardless of HIV status.

Conclusions: We found substantial mortality among HIV-negative patients with PJP, and adjuvant corticosteroid use was associated with decreased mortality. Response to corticosteroids is best established in HIV-infected patients, but emerging reports suggest a similar beneficial response in PJP patients without HIV infection. Further prospective studies may establish a more definitive role of the addition of corticosteroids among HIV-negative patients with PJP.

Keywords: HIV negative; Pneumocystis jirovecii pneumonia; prognosis; retrospective corticosteroid adjuvant therapy.