{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:00:12Z","timestamp":1780581612385,"version":"3.54.1"},"reference-count":97,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K43TW011421"],"award-info":[{"award-number":["K43TW011421"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AI170426"],"award-info":[{"award-number":["U01AI170426"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The performance of chest x-ray (CXR) features for Pneumocystis pneumonia (PCP) diagnosis has been evaluated in small studies. We conducted a systematic review and meta-analysis to describe CXR changes in adults with HIV-associated laboratory-confirmed PCP, comparing these with non-PCP respiratory disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched databases for studies reporting CXR changes in people &amp;gt;15 years old with HIV and laboratory-confirmed PCP and those with non-PCP respiratory disease. CXR features were grouped using consensus terms. Proportions were pooled and odds ratios (ORs) generated using random-effects meta-analysis, with subgroup analyses by CD4 count, study period, radiology review method, and study region.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fifty-one studies (with 1821 PCP and 1052 non-PCP cases) were included. Interstitial infiltrate (59%; 95% CI, 52%\u201366%; 36 studies, n = 1380; I2 = 85%) and ground-glass opacification (48%; 95% CI, 15%\u201383%; 4 studies, n = 57; I2 = 86%) were common in PCP. Cystic lesions, central lymphadenopathy, and pneumothorax were infrequent. Pleural effusion was rare in PCP (0%; 95% CI, 0%\u20132%). Interstitial infiltrate (OR, 2.3; 95% CI, 1.4\u20133.9; I2 = 60%), interstitial\u2013alveolar infiltrate (OR, 10.2; 95% CI, 3.2\u201332.4; I2 = 0%), and diffuse CXR changes (OR, 7.3; 95% CI, 2.7\u201320.2; I2 = 87%) were associated with PCP diagnosis. There was loss of association with alveolar infiltrate in African studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Diffuse CXR changes and interstitial\u2013alveolar infiltrates indicate a higher likelihood of PCP. Pleural effusion, lymphadenopathy, and focal alveolar infiltrates suggest alternative causes. These findings could be incorporated into clinical algorithms to improve diagnosis of HIV-associated PCP.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofae146","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T09:13:35Z","timestamp":1710753215000},"source":"Crossref","is-referenced-by-count":7,"title":["Chest X-ray Features of HIV-Associated <i>Pneumocystis<\/i> Pneumonia (PCP) in Adults: A Systematic Review and Meta-analysis"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9471-5397","authenticated-orcid":false,"given":"Nicola K","family":"Wills","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Cape Town , Cape Town , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marguerite","family":"Adriaanse","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cape Town , Cape Town , South 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