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Background:  Significant improvements in outcomes for hospitalized patients with Pneumocystis jeroveci pneumonia (PCP) have been described in the United States. However, the epidemiology of PCP-related hospitalizations in HIV patients using a nationally representative sample of the United States has not been previously described.

Methods:   From the National Hospital Discharge Survey from 1986 to 2002 we used the 9th revision of the International Disease Classification (ICD-9) to define HIV-related symptomatic disease and PCP. We then examined demographic and outcome variables including sex, age, race, region of the country, hospital type, payment type, length of stay, in-hospital mortality, mechanical ventilation, and discharge to a short or long-term nursing care facility. We further categorized the time period from 1986 to 1989 as the pre-prophylaxis era, the time period from 1990 to 1995 as the pre-HAART era, and the time period from 1996 to 2002 as the HAART era.

Results:  From 1986 to 2002, there was a total of 1,862,000 hospital discharges with symptomatic HIV or AIDS of which 15% had PCP (283,700 discharges). There was an increase in the number of PCP discharges from 1986 to 1996 followed by a drop in 1989 after the introduction of PCP prophylaxis. In the post HAART era, from 1997 until 2002, the number of PCP discharges remained stable at an average of 10,000/year. The in-hospital mortality for PCP decreased from the pre-prophylaxis era (21%) to the prophylaxis (16.5%) and HAART (11%) eras (p for trend < 0.0001). When stratifying by race, the age-adjusted in-hospital mortality in whites decreased from 25% in the combined pre-prophylaxis and pre-HAART eras to10% in the HAART era (p = 0.002). In contrast, the in-hospital mortality for blacks did not change significantly (15% pre-prophylaxis and pre-HAART vs 16% in the HAART era; p = 0.686). The proportion of PCP-related hospitalizations in the south and for females and blacks has increased over time. Although the number of hospital days for PCP has decreased, the proportion of patients discharged to a long or short term nursing care facility has increased.

Conclusions:  The number of hospitalizations and in-hospital mortality for PCP in HIV-infected patients has decreased significantly. However, geographic and demographic trends in hospitalization suggest that PCP is becoming more frequent in minority groups with less health care access.

Keywords: Pneumocystis carinii; HIV hospitalizations; Racial/Ethnic disaparities