Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study
| dc.contributor.advisor | Wasserman, Sean | |
| dc.contributor.author | Wills, Nicola | |
| dc.date.accessioned | 2025-10-02T11:56:59Z | |
| dc.date.available | 2025-10-02T11:56:59Z | |
| dc.date.issued | 2025 | |
| dc.date.updated | 2025-10-02T11:35:05Z | |
| dc.description.abstract | Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings. Methods: We conducted a case-control study involving HIV-positive adults with laboratory-confirmed PCP and a matched cohort with non-PCP respiratory presentations at regional hospitals in Cape Town, South Africa (2012 – 2020). The primary objective was to identify CXR features associated with confirmed PCP diagnosis and severe PCP (defined by hypoxia, ICU referral/admission, and/or in-hospital death). We explored the performance of logistic regression models, incorporating selected clinical and CXR predictors, for PCP diagnosis and severe PCP. Results: Records from 104 adults (52 PCP cases and 52 non-PCP controls) were included. Diffuse versus patchy ground glass opacification was associated with increased odds of PCP diagnosis (adjusted odd's ratio (aOR) 6.2, 95% confidence interval (CI) 1.6 – 28.9, p =0.01) and severe PCP (aOR 4.5, 95%CI 1.6 – 14.4, p =0.008). Consolidation was associated with severe PCP (aOR 3.3, 95%CI 1.2 –11.0, p =0.03) as was increasing ground glass zone involvement (aOR 2.1 for each one-unit increase in involved zone; 95% CI, 1.4 – 3.2, p = 0.0004). Models incorporating hypoxia (hypoxia model) or tachypnoea (respiratory rate model) with diffuse ground glass opacities, absence of pleural effusion or reticular/reticulonodular changes on CXR performed well in predicting PCP (area under the receiver operating characteristic curve 0.828 (hypoxia model) and 0.857 (respiratory rate model). Conclusions: CXR evaluation alongside bedside clinical information offers good accuracy for discriminating definite PCP from other HIV-associated respiratory diseases. | |
| dc.identifier.apacitation | Wills, N. (2025). <i>Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/41979 | en_ZA |
| dc.identifier.chicagocitation | Wills, Nicola. <i>"Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2025. http://hdl.handle.net/11427/41979 | en_ZA |
| dc.identifier.citation | Wills, N. 2025. Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study. . University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/41979 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Wills, Nicola AB - Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings. Methods: We conducted a case-control study involving HIV-positive adults with laboratory-confirmed PCP and a matched cohort with non-PCP respiratory presentations at regional hospitals in Cape Town, South Africa (2012 – 2020). The primary objective was to identify CXR features associated with confirmed PCP diagnosis and severe PCP (defined by hypoxia, ICU referral/admission, and/or in-hospital death). We explored the performance of logistic regression models, incorporating selected clinical and CXR predictors, for PCP diagnosis and severe PCP. Results: Records from 104 adults (52 PCP cases and 52 non-PCP controls) were included. Diffuse versus patchy ground glass opacification was associated with increased odds of PCP diagnosis (adjusted odd's ratio (aOR) 6.2, 95% confidence interval (CI) 1.6 – 28.9, p =0.01) and severe PCP (aOR 4.5, 95%CI 1.6 – 14.4, p =0.008). Consolidation was associated with severe PCP (aOR 3.3, 95%CI 1.2 –11.0, p =0.03) as was increasing ground glass zone involvement (aOR 2.1 for each one-unit increase in involved zone; 95% CI, 1.4 – 3.2, p = 0.0004). Models incorporating hypoxia (hypoxia model) or tachypnoea (respiratory rate model) with diffuse ground glass opacities, absence of pleural effusion or reticular/reticulonodular changes on CXR performed well in predicting PCP (area under the receiver operating characteristic curve 0.828 (hypoxia model) and 0.857 (respiratory rate model). Conclusions: CXR evaluation alongside bedside clinical information offers good accuracy for discriminating definite PCP from other HIV-associated respiratory diseases. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - X-ray KW - HIV LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study TI - Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study UR - http://hdl.handle.net/11427/41979 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/41979 | |
| dc.identifier.vancouvercitation | Wills N. Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study. []. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/41979 | en_ZA |
| dc.language.iso | en | |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject | X-ray | |
| dc.subject | HIV | |
| dc.title | Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MMed |