HIV Research and Clinical Practice · Available online 28 Jan 2026 · In press · DOI 10.1080/25787489.2026.2621466
Background Pneumocystis jirovecii pneumonia (PJP) remains a leading opportunistic infection in people with HIV and severe immunodeficiency. While PJP treatment has been well studied, the clinical significance of cytomegalovirus (CMV) DNA detection during PJP and the role of specific anti-CMV therapy remain uncertain. Objectives To examine associations between CMV DNA detection, anti-CMV therapy, and clinical outcomes in people with HIV hospitalized with PJP. Methods This retrospective cohort study examined people with HIV hospitalized with PJP between 2008 and 2022 at University Hospital Bulovka. A customized severity index was developed for this cohort. In-hospital mortality, one-year survival, and disease severity were assessed, focusing on CMV DNA detection and its treatment. Data were analyzed using Firth penalized logistic regression to identify associations with clinical outcomes, and ordinal logistic regression to assess predictors of severity scores in this observational cohort. Results One hundred and one patients were included. In unadjusted analyses, CMV DNA detection was associated with higher odds of both in-hospital and one-year mortality, and anti-CMV therapy was associated with increased in-hospital mortality. In multivariable analyses, CMV DNA detection was not independently associated with in-hospital or one-year mortality, although point estimates consistently suggested higher odds of death. Receipt of anti-CMV therapy was not independently associated with mortality after adjustment. The severity index was independently associated with both in-hospital and one-year mortality. CMV DNA detection and anti-CMV therapy were independently associated with greater disease severity in ordinal regression analyses. Anti-CMV therapy was more frequently administered to patients with more severe disease and was also associated with in-hospital mortality. Conclusions CMV DNA detection in people with HIV hospitalized with PJP was associated with worse outcomes. Anti-CMV therapy was more often used in severe cases and showed an association with in-hospital mortality in unadjusted analyses. The observational design precludes determination of causality.
Abstract from DOAJ. Public domain (CC0 1.0).
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