Possible Diagnostic Delays and Missed Prevention Opportunities in Pneumocystis Pneumonia Patients Without HIV: Analysis of Commercial Insurance Claims Data—United States, 2011–2015
Jeremy A.W. Gold, Brendan R. Jackson, Kaitlin Benedict
Abstract
Abstract Background Pneumocystis pneumonia (PCP) is a life-threatening but treatable and preventable fungal infection in immunocompromised persons. Previous studies suggest that persons without HIV who develop PCP (PCPHIV-) experience more acute, severe illness than persons with HIV who develop PCP (PCPHIV+). We analyzed health insurance claims data to compare demographics, underlying conditions, symptoms, and prescriptions for PCPHIV+ and PCPHIV-. Methods We used the IBM MarketScan Research Databases to identify patients diagnosed with PCP during 2011–2015. We analyzed claims 1 year before to 3 months after diagnosis to compare PCPHIV+ and PCPHIV-. Results Among 3938 patients, 70.4% were PCPHIV-. Compared with PCPHIV+, PCPHIV- were more likely to be older (median, 60 vs 45 years; P < .0001), female (51.5% vs 20.2%; P < .0001), hypoxemic (13.5% vs 7.1%; P < .0001), and to die within 90 days (6.6% vs 4.2%; P < .0001). The most common underlying conditions among PCPHIV- included chronic pulmonary diseases (54.6%), solid tumors (35.1%), hematologic malignancies (20.1%), and rheumatologic conditions (14.0%). The median time between the first visit for PCP-related symptoms and PCP diagnosis was longer for PCPHIV- than PCPHIV+ (25 vs 16 days; P < .0001). In the 3 months before PCP diagnosis, PCPHIV- were less likely to have an outpatient prescription for PCP prophylaxis than PCPHIV+ (6.9% vs 10.6%; P = .0001). Conclusions PCPHIV- may experience a prolonged illness course and diagnostic delays compared with PCPHIV+. Clinicians should maintain a high index of suspicion for PCP in immunocompromised patients with compatible symptoms, regardless of HIV status.