Outcome and Diagnosis of HIV-associated Pneumocystis Pneumonia
Name: Anne Berhe
School: Vagelos College of Physicians and Surgeons, Class of 2026; Varmus Global Scholar 2023
Mentor: James Brust, MD and Michael Yin, MD, MS
Abstract
Research Question: In this study, we seek to identify the clinical phenotype and pathogen characteristics specific to HIV-associated PCP in African populations.
Background: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic fungal infection that can cause severe respiratory illness. PCP incidence rose during the HIV epidemic in the 1980s and it remains one of the most common AIDS-defining illnesses. HIV-associated PCP is linked to poor outcomes in sub-Saharan Africa and is exacerbated by significant gaps in diagnosis and treatment.
Methods: We will enroll 80 adult patients in Khayelitsha District Hospital, South Africa who are living with HIV and have suspected PCP. Participants are followed for 90 days and periodically have clinical testing and questionnaires administered to document their health during and post-treatment. All participants will be assessed for bronchoscopy for additional immunologic and microbiologic studies. Finally, we will conduct qualitative interviews to further our understanding of the lived experiences of those diagnosed with PCP.
Results: To date, we have enrolled 18 participants (8 male, 10 female), 2 of whom died during the study period. At time of enrollment, the mean CD4 count was 56 cells/mm3 [range 5-155] and the mean weight was 58.5 kg [range 34-90]. Only 2/18 were on ART and all participants had a detectable HIV-1 viral load (mean 734,572 copies/mL).
Conclusions: These baseline characteristics of the study population provide insight into the types of patients that are receiving treatment for HIV-associated PCP and may inform strategies to target treatment for individuals in this region of South Africa.