CC BY 4.0 · Avicenna J Med 2023; 13(01): 023-034
DOI: 10.1055/s-0043-1764375
Review Article

Pneumocystis jiroveci Pneumonia: A Review of Management in Human Immunodeficiency Virus (HIV) and Non-HIV Immunocompromised Patients

Atif Ibrahim
1   North Mississippi Medical Center, Tupelo, Mississippi, United States
Asmi Chattaraj
2   University of Pittsburgh Medical Center, McKeesport, Pennsylvania, United States
Qamar Iqbal
3   TidalHealth, Salisbury, Maryland, United States
Ali Anjum
4   King Edward Medical University, Lahore, Pakistan
Mohammad Ebad Ur Rehman
5   Rawalpindi Medical University, Rawalpindi, Pakistan
Zobia Aijaz
6   Dow Medical College, Karachi, Pakistan
Fazila Nasir
7   Allama Iqbal Medical College, Lahore, Pakistan
Sadia Ansar
8   Rawal Institute of Health Sciences, Islamabad, Pakistan
Tirdad T. Zangeneh
9   Division of Infectious Diseases, Department of Medicine, University of Arizona, Tucson, Arizona, United States
Ahmad Iftikhar
10   Department of Internal Medicine, University of Arizona, Tucson, Arizona, United States
› Author Affiliations
Funding None.


Pneumocystis jirovecii pneumonia is an opportunistic fungal infection that was mainly associated with pneumonia in patients with advanced human immunodeficiency virus (HIV) disease. There has been a decline in Pneumocystis jirovecii pneumonia incidence in HIV since the introduction of antiretroviral medications. However, its incidence is increasing in non-HIV immunocompromised patients including those with solid organ transplantation, hematopoietic stem cell transplantation, solid organ tumors, autoimmune deficiencies, and primary immunodeficiency disorders. We aim to review and summarize the etiology, epidemiology, clinical presentation, diagnosis, and management of Pneumocystis jirovecii pneumonia in HIV, and non-HIV patients. HIV patients usually have mild-to-severe symptoms, while non-HIV patients present with a rapidly progressing disease. Induced sputum or bronchoalveolar lavage fluid can be used to make a definitive diagnosis of Pneumocystis jirovecii pneumonia. Trimethoprim-sulfamethoxazole is considered to be the first-line drug for treatment and has proven to be highly effective for Pneumocystis jirovecii pneumonia prophylaxis in both HIV and non-HIV patients. Pentamidine, atovaquone, clindamycin, and primaquine are used as second-line agents. While several diagnostic tests, treatments, and prophylactic regimes are available at our disposal, there is need for more research to prevent and manage this disease more effectively.

Availability of Data and Materials

All data generated or analyzed during this study are included in this published article in the reference section.

Publication History

Article published online:
24 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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