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Differential composition of the pulmonary microbiome in HIV-positive versus HIV-negative patients with Pneumocystis jirovecii

Summary

This study compared lung infections in HIV-positive and HIV-negative patients who both had Pneumocystis jirovecii. Researchers found that HIV-positive patients had more diverse microorganisms in their lungs, particularly viruses, yet generally did better. HIV-negative patients had fewer types of microorganisms but worse outcomes. The findings suggest that the way a person’s immune system is weakened matters more than just having many germs present.

Background

Pneumocystis jirovecii (PJ) is an opportunistic infection found worldwide, commonly in HIV patients and immunocompromised individuals. While PJ infections progress differently between HIV and non-HIV patients, with non-HIV patients showing worse outcomes despite lower microbial burden, the underlying mechanisms remain unclear. This study investigates the pulmonary microbiota differences between these two patient groups.

Objective

To compare the differences in pulmonary microbiota composition between HIV-positive and HIV-negative patients with confirmed Pneumocystis jirovecii infection using next-generation sequencing of bronchoalveolar lavage fluid.

Results

HIV-positive patients exhibited greater microbial diversity with 88.5% experiencing viral co-infections (primarily herpesviruses), 61.5% bacterial, and 40.4% fungal co-infections. Non-HIV patients predominantly had bacterial co-infections (72%), followed by viral (52%) and fungal (36%) infections. Statistical differences were significant for viral infections (p<0.001), with higher frequencies of Leptospiral virus, Rosette fungus, and Actinomycetes in HIV patients.

Conclusion

HIV-positive PJ patients showed greater lung microbiota diversity and higher pathogen co-infection rates, yet had better clinical outcomes than non-HIV patients. This suggests that factors beyond microbial burden, such as host immune dysregulation specific to non-HIV immunosuppression, critically influence disease severity and prognosis in PJ infection.
  • Published in:PLoS One,
  • Study Type:Retrospective Cohort Study,
  • Source: PMID: 41071776, DOI: 10.1371/journal.pone.0334220
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