Trends in hospitalizations for AIDS-associated Pneumocystis jirovecii Pneumonia in the United States (1986 to 2005).
BACKGROUND
Although hospitalizations for AIDS-associated Pneumocystis jirovecii pneumonia (PCP) in the United States have decreased since the introduction of chemoprophylaxis and potent combination antiretroviral therapy (ART), PCP remains an important cause of illness and death among AIDS patients.


METHODS
We analyzed trends in AIDS-associated PCP hospital discharges using the National Hospital Discharge Surveys between 1986 and 2005.


RESULTS
An estimated 539 million patients were discharged from hospitals between 1986 and 2005, of whom an estimated 312,411 had AIDS-associated PCP. The proportion of patients discharged from the hospital with AIDS-associated PCP decreased from 31% before the introduction of chemoprophylaxis (1986 to 1989) to 17% with chemoprophylaxis (1990 to 1995) and subsequently to 9% after the introduction of ART in 1996 (p < 0.001). Mortality from AIDS-associated PCP decreased from 21 to 16% and subsequently to 7% between these three time periods (p < 0.001). Among those who received mechanical ventilation, mortality decreased from 79% in the prechemoprophylaxis era to 31% in the ART era (p < 0.001) alongside an increase (from 5 to 11%) in the use of mechanical ventilation. We also observed a shift in the population at-risk for PCP over time: a greater proportion of black people, women, and people from Southern states were affected (all p < 0.001).


CONCLUSIONS
While there have been significant reductions in hospitalizations and hospital mortality for AIDS-associated PCP over the last 20 years, these reductions have not been homogenous across demographic subpopulations and geographic regions and point to new at-risk populations. Furthermore, mortality in severe cases of PCP that require mechanical ventilation has improved substantially.
Kelley
Colleen F
CF
Division of Infectious Diseases and the Emory Center for AIDS Research, Department of Medicine, Emory University, Atlanta, GA.
Checkley
William
W
Division of Pulmonary and Critical Care, Department of Medicine, The Johns Hopkins University, Baltimore, MD. Electronic address: wcheckl1@jhmi.edu.
Mannino
David M
DM
Division of Pulmonary and Critical Care, Department of Medicine, University of Kentucky, Lexington, KY.
Franco-Paredes
Carlos
C
Division of Infectious Diseases and the Emory Center for AIDS Research, Department of Medicine, Emory University, Atlanta, GA.
Del Rio
Carlos
C
Division of Infectious Diseases and the Emory Center for AIDS Research, Department of Medicine, Emory University, Atlanta, GA.
Holguin
Fernando
F
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents