Pulmonary infection and respiratory failure are the most common causes of admission to the intensive care unit (ICU) in human immunodeficiency virus (HIV)-positive patients. 1,2 In our experience, in a developing nation (despite the advent of HAART), the commonest cause of admission to ICU and mechanical ventilation still remains Pneumocystis jiroveci pneumonia (PJP). Most of these patients presenting with PJP have not been on antiretroviral therapy (ART) or been treated with PJP prophylaxis, and it is highly likely that this is their first time presentation to hospital. 3 The advent of highly active antiretroviral therapy (HAART) has allowed for more effective treatment of HIV-positive patients; however, despite this, PJP remains the most common acquired immunodeficiency syndrome (AIDS)-defining condition and is associated with much morbidity and mortality, in both developing and developed nations. 4 In developed countries, mortality may reach up to 85%, while, in developing countries, the mortality figu...