Analysis of fatal cases of pneumocystis pneumonia in HIV-infected patients with COVID-19

The aim: to determine the impact of a new coronavirus infection on the course of pneumocystis pneumonia in patients with HIV infection. Materials and methods. A retrospective analysis of 45 medical records of patients who died in the intensive care unit of the S. P. Botkin Clinical Infectious Diseases Hospital between March 2020 and January 2023 was conducted. Of the 45 patients with Pneumocystis pneumonia, the new coronavirus infection was also verified in 26 patients. Anamnestic and clinical data, laboratory and instrumental research results, pathological findings were compared in groups of patients with Pneumocystis pneumonia with/without co-infection with COVID-19. Results and discussion. The patient groups were comparable in terms of gender, age, duration of HIV infection, severity of immunodeficiency, and intensity of HIV viremia. The main clinical manifestations (fever level, cough, signs of respiratory failure, auscultatory picture in the lungs), as well as the indicators of routine laboratory tests (hemogram, concentration of LDH, CRP, ferritin, D-dimer) did not differ statistically in the groups. The radiological picture of changes in the lungs was similar, as well as the duration of hospital stay (bed days) in the groups did not differ. Analysis of the results of pathological reports showed that in most cases ( 2 ⁄3of patients), COVID-19 did not have a significant impact on the course and outcome of the disease, being a concomitant pathology. However, in every third patient, signs of viral pneumonia were postmortem along with specific Pneumocystis cystic lung damage. Conclusion. COVID-19 coronavirus infection in patients with pneumocystosis does not significantly change the clinical picture, laboratory and radiological manifestations of pneumonia and in most cases does not affect its course and outcome. However, in a third of cases, coronavirus pneumonia was the cause of death along with pneumocystis.