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

Publication ,  Journal Article
Yoon, C; Subramanian, A; Chi, A; Crothers, K; Meshnick, SR; Taylor, SM; Beard, CB; Jarlsberg, LG; Lawrence, GG; Avery, M; Swartzman, A ...
Published in: Med Mycol
August 2013

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.

Duke Scholars

Published In

Med Mycol

DOI

EISSN

1460-2709

Publication Date

August 2013

Volume

51

Issue

6

Start / End Page

568 / 575

Location

England

Related Subject Headings

  • Pneumonia, Pneumocystis
  • Pneumocystis carinii
  • Mutation
  • Mutant Proteins
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • HIV Infections
  • Female
 

Citation

APA
Chicago
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MLA
NLM
Yoon, C., Subramanian, A., Chi, A., Crothers, K., Meshnick, S. R., Taylor, S. M., … International HIV-Associated Opportunistic Pneumonias (IHOP) Study. (2013). Dihydropteroate synthase mutations in Pneumocystis pneumonia: impact of applying different definitions of prophylaxis, mortality endpoints and mutant in a single cohort. Med Mycol, 51(6), 568–575. https://doi.org/10.3109/13693786.2013.770604
Journal cover image

Published In

Med Mycol

DOI

EISSN

1460-2709

Publication Date

August 2013

Volume

51

Issue

6

Start / End Page

568 / 575

Location

England

Related Subject Headings

  • Pneumonia, Pneumocystis
  • Pneumocystis carinii
  • Mutation
  • Mutant Proteins
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • HIV Infections
  • Female