944 - Pneumocystis-Tuberculosis Co-infection in the HIV Positive Host.

Background: Concurrent infection with Pneumocystis Jirovecii (PJP) and Tuberculosis (TB) has been described in HIV infected patients. Developed countries, where guidelines on the treatment of PJP have been created have dramatically lower rates of latent and active TB than developing countries. PJP may obscure the diagnosis or delay the treatment of TB. Furthermore, treatment of PJP with corticosteroids may be detrimental to the course of TB.  The objective of this study was to examine the frequency and the clinical characteristics of the co-infection of PJP and TB in HIV.

Methods: The clinical details of all HIV patients being treated at Amrita Hospital in South India have been prospectively collected in an electronic database since 2006. We compiled the data from 2006 to 2018 and further examined the clinical and laboratory results from electronic charts of patients admitted with PJP. Statistical analysis of the data was performed with descriptive analysis.

Results: A total of 21 of the 576 HIV patients were had admissions for PJP. Of these, 43% were co-infected with PJP and TB. In all cases PJP was the opportunistic infection leading to a HIV diagnosis. When comparing the PJP and MTB group with the PJP only group, the dual infected group was younger (40 vs 45), however there was no difference in length of stay (16.5 days vs 11.8), ICU admission rate (33% vs 36%), or mortality (0 vs 3 patients died).Demographic Data
Comparison of TB-PCP and PCP only groups


Conclusion: Our report highlights the need to increase awareness of occurrence of this dual infection in HIV infected patients, as both infections can mimic each other clinically and radiologically, and are potentially fatal if not recognized promptly. Furthermore tuberculosis has the risk of transmission to health care personnel and other patients. In addition we report a much higher rate of underlying TB in our patients with PJP than what has been generally reported in the literature and conclude that higher clinical suspicion for this entity is warranted, particularly in countries with a high prevalence of TB.Immunology and Pathophysiology of HIV-PJP-TB triple infection