Dihydropteroate synthase mutations in Pneumocystis pneumonia: impact of applying different definitions of prophylaxis, mortality endpoints and mutant in a single cohort.

Journal Article (Journal Article)

Pneumocystis jirovecii dihydropteroate synthase (DHPS) gene mutations are well-reported. Although sulfa prophylaxis generally is associated with DHPS mutant infection, whether mutant infection is associated with poorer clinical outcomes is less clear. The differing definitions of sulfa prophylaxis and the different mortality endpoints used in these studies may be one explanation for the conflicting study results. Applying different definitions of prophylaxis, mortality endpoints and DHPS mutant to 301 HIV-infected patients with Pneumocystis pneumonia, we demonstrate that prophylaxis, irrespective of definition, increased the risk of infection with pure mutant (any prophylaxis: AOR 4.00, 95% CI: 1.83-8.76, P < 0.001) but not mixed genotypes (any prophylaxis: AOR 0.78, 95% CI: 0.26-2.36, P = 0.65). However, infection with mutant DHPS, irrespective of definition, was not associated with increased mortality (all-cause or PCP death) at the three time-intervals examined (all P > 0.05). Future studies should standardize key variables associated with DHPS mutant infection as well as examine DHPS mutant subtypes (pure mutant vs. mixed infections) - perhaps even individual DHPS mutant genotypes - so that data can be pooled to better address this issue.

Full Text

Duke Authors

Cited Authors

  • Yoon, C; Subramanian, A; Chi, A; Crothers, K; Meshnick, SR; Taylor, SM; Beard, CB; Jarlsberg, LG; Lawrence, GG; Avery, M; Swartzman, A; Fong, S; Roth, B; Huang, L; International HIV-Associated Opportunistic Pneumonias (IHOP) Study,

Published Date

  • August 2013

Published In

Volume / Issue

  • 51 / 6

Start / End Page

  • 568 - 575

PubMed ID

  • 23470037

Pubmed Central ID

  • PMC4008324

Electronic International Standard Serial Number (EISSN)

  • 1460-2709

Digital Object Identifier (DOI)

  • 10.3109/13693786.2013.770604


  • eng

Conference Location

  • England