Abstract

WILLS, Nicola K.; TAVARES, Jared; SAID-HARTLEY, Qonita  and  WASSERMAN, Sean. Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study. South. Afr. j. HIV med. (Online) [online]. 2024, vol.25, n.1, pp.1-10. ISSN 2078-6751.  https://doi.org/10.4102/sajhivmed.v25i1.1636.

BACKGROUND: Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings. OBJECTIVES: Our primary objective was to identify CXR features associated with confirmed PCP diagnosis and severe PCP (defined by hypoxia, intensive care unit referral/admission, and/or in-hospital death). We also explored the performance of logistic regression models, incorporating selected clinical and CXR predictors, for PCP diagnosis and severe PCP. METHOD: We conducted a case-control study involving HIV-positive adults with laboratory-confirmed PCP and a matched cohort with non-PCP respiratory presentations at regional hospitals in Cape Town, South Africa (2012-2020. RESULTS: Records from 104 adults (52 PCP cases and 52 non-PCP controls) were included. Diffuse versus patchy ground-glass opacification was associated with increased odds of PCP diagnosis (adjusted odds ratio [aOR]: 6.2, 95% confidence interval [CI]: 1.6-28.9, P = 0.01) and severe PCP (aOR: 4.5, 95% CI: 1.6-14.4, P = 0.008). Consolidation was associated with severe PCP (aOR: 3.3, 95% CI: 1.2-11.0, P = 0.03) as was increasing ground-glass zone involvement (aOR: 2.1 for each one-unit increase in involved zone; 95% CI: 1.4-3.2, P = 0.0004). Models incorporating hypoxia (hypoxia model) or tachypnoea (respiratory rate model) with diffuse ground-glass opacities, absence of pleural effusion or reticular/reticulonodular changes on CXR performed well in predicting PCP (area under the receiver operating characteristic curve 0.828 [hypoxia model] and 0.857 [respiratory rate model. CONCLUSION: CXR evaluation alongside bedside clinical information offers good accuracy for discriminating definite PCP from other HIV-associated respiratory diseases.

Keywords : HIV; PCP; Pneumocystis jirovecii; chest X-ray; prediction rule.

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