The early initiation of antiretroviral therapy (ART) in HIV-infected patients shortly after the initiation of treatment for Pneumocystis pneumonia (PCP) has not been fully validated in a clinical setting. We retrospectively extracted all patients diagnosed with HIV-related PCP (HIV-PCP), including those with severe cases, who were treated with first-line ART in our hospital. The HIV-PCP patients were divided into two groups: an early ART group (patients who commenced ART within 21 days after the start of PCP treatment) and a deferred ART group (patients who started ART after 22 days). We compared the incidence of AIDS progression or death, the virological suppression rate, and changes in the CD4⁺ cell count at 24 weeks after the initiation of ART between the two groups. In addition, we analyzed the incidences of immune reconstitution inflammatory syndrome and grade 3 or 4 laboratory and clinical adverse events within 24 weeks as safety outcomes. Ninety-one HIV-PCP patients (36 in the early ART group and 55 in the deferred group) were included in this study. We found no significant difference in the incidence of AIDS progression or death between the two groups. Virological outcomes tended to be better in the early ART group but were not significantly different. Increases in the CD4⁺ cell counts at 24 weeks were comparable in both groups, suggesting that the safety was not significantly different. Analysis of the propensity-score matched cohort was performed to adjust for selection bias, and no significant difference was found in any outcome. Our results suggest that early ART introduction can be considered for untreated HIV-positive patients with PCP on the basis of efficacy and safety.

中文翻译：

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HIV-1感染者合并吉氏肺孢子菌早期抗逆转录病毒治疗疗效的回顾性分析

在开始治疗肺孢子虫肺炎 (PCP)后不久，在 HIV 感染患者中早期开始抗逆转录病毒治疗 (ART)尚未在临床环境中得到充分验证。我们回顾性提取了所有在我院接受一线 ART 治疗的确诊为 HIV 相关 PCP (HIV-PCP) 的患者，包括重症患者。HIV-PCP 患者分为两组：早期 ART 组（在 PCP 治疗开始后 21 天内开始 ART 的患者）和延迟 ART 组（在 22 天后开始 ART 的患者）。我们比较了 AIDS 进展或死亡的发生率、病毒学抑制率和 CD4 ⁺两组间在 ART 开始后 24 周时的细胞计数。此外，我们分析了 24 周内免疫重建炎症综合征和 3 级或 4 级实验室和临床不良事件的发生率作为安全性结果。本研究包括 91 名 HIV-PCP 患者（早期 ART 组 36 名和延迟组 55 名）。我们发现两组之间 AIDS 进展或死亡的发生率没有显着差异。早期 ART 组的病毒学结果往往更好，但没有显着差异。增加CD4 ⁺24 周时的细胞计数在两组中具有可比性，表明安全性没有显着差异。对倾向评分匹配的队列进行分析以调整选择偏倚，没有发现任何结果的显着差异。我们的结果表明，基于有效性和安全性，可以考虑对未经治疗的 HIV 阳性 PCP 患者早期引入 ART。