Pulmonary outcomes are more severe among HIV-infected children with pneumocystis pneumonia than in children with primary immunodeficiency

Abstract

333 Pulmonary Outcomes Are More Severe Among HIV-Infected Children With Pneumocystis Pneumonia Than in Children With Primary Immunodeficiency K. S. Brauer1, N. Tangsinmankong1, J. W. Sleasman1, S. Skoda Smith2; 1University of South Florida, St. Petersburg, FL, 2University of Florida, Gainesville, FL. RATIONALE: Despite a clear distinction in underlying pathogenesis between primary and acquired T cell immunodeficiency, no comparable data is available on the clinical outcomes and prognosis of Pneumocystis jirovecii pneumonia (PCP). METHODS: A retrospective analysis of infants < 2 years with confirmed PCP and either primary immunodeficiency or HIV infection was performed. PCP was confirmed by positive silver methionine staining on bronchoalveolar lavage, open biopsy, or tracheal aspirate. The two groups were assessed for the extent of immune suppression, incidence of respiratory failure, degree of hypoxia, and serum LDH levels. RESULTS: Thirty-seven children were evaluated. Ten children had primary immunodeficiency (PID), mean age 6.9 ± 2.8 mo ± SD, M:F ratio 4:1. Twenty-seven children had HIV infection, mean age 5.8 ± 3.5 mo ± SD, M:F ratio 0.9:1. At PCP diagnosis, CD4:CD8 ratios in the PID group were higher than in the HIV group (mean ± SD 1.47 ± 0.9 vs. 0.8 ± 0.6, respectively, p = .025). Respiratory failure defined as the need for intubation occurred more frequently in the HIV group (22/27) than in the PID group (2/10); p = .003. Immunologic parameters (including immunoglobulins, CD3, CD4, and CD8 counts), LDH, and PaO2/FiO2 ratio at the time of PCP diagnosis were similar between the two groups. Of note, LDH values were elevated in 83% of these children (mean 1404.7 IU/L). CONCLUSIONS: HIV/PCP co-infection leads a greater pulmonary inflammatory response resulting in more severe respiratory manifestations when compared to children with PCP and PID.