{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T10:32:26Z","timestamp":1787999546213,"version":"build-2784847793"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T00:00:00Z","timestamp":1607040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The effectiveness of trimethoprim\/sulfamethoxazole (TMP\/SMZ) for pneumocystis pneumonia (PCP) is limited with adverse events. Caspofungin, by inhibiting the cyst form of <jats:italic>Pneumocystis jirovecii<\/jats:italic>, may be an alternative therapy for PCP. However, the availability of clinical data about caspofungin combined with TMP\/SMZ in the treatment of PCP in HIV\u2010infected patients is limited. Thus, we aimed to examine the clinical effectiveness and safety of caspofungin combined with TMP\/SMZ as a first\u2010line therapy for moderate\u2010to\u2010severe PCP in HIV\u2010infected patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January 2017 to December 2019, data of HIV\u2010infected patients with moderate\u2010to\u2010severe PCP who received either TMP\/SMZ alone or caspofungin combined with TMP\/SMZ as first\u2010line therapy were retrospectively reviewed to assess the effectiveness and safety of each regimen. The Kaplan\u2013Meier curve and log\u2010rank test were used for survival analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 278 patients met the criteria. The overall positive response rate of PCP treatment was 48.92%, and the overall all\u2010cause in\u2010hospital mortality rate was 33.09%. Patients who received combination therapy consisting of caspofungin and TMP\/SMZ had a better positive response rate (59.44% <jats:italic>vs<\/jats:italic>. 37.78%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and lower all\u2010cause in\u2010hospital mortality rate (24.48% <jats:italic>vs<\/jats:italic>. 42.22%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003). Also, patients who received combination therapy had higher survival rate during a hospital stay (75.52% <jats:italic>vs<\/jats:italic>. 57.78%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.004), and those who received longer combination therapy were more likely to have higher survival rate (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.042). We found that age (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.019), CD4 cell count (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001) and therapeutic regimen (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.002) were significant risk factors for all\u2010cause in\u2010hospital mortality rate in univariate analysis. In multivariate analysis, only CD4 cell count and therapeutic regimen were statistically significant factors associated with all\u2010cause in\u2010hospital mortality rate. Patients with a CD4 count of &gt;\u00a030\u00a0cells\/\u00b5L and patients who received combination therapy consisting of caspofungin and TMP\/SMZ were more likely to survive from PCP (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.011 and <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002, respectively). There were no additional severe adverse events caused by adding caspofungin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For HIV\u2010infected patients with moderate\u2010to\u2010severe PCP, combination therapy with caspofungin and TMP\/SMZ is an effective and promising first\u2010line therapy with no greater number of adverse events compared with TMP\/SMZ monotherapy. Patients who received caspofungin had better positive response rates and lower all\u2010cause in\u2010hospital mortality rates. Also, we recommend early initiation of caspofungin.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.13013","type":"journal-article","created":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T06:29:11Z","timestamp":1607149751000},"page":"307-313","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Caspofungin combined with TMP\/SMZ as a first\u2010line therapy for moderate\u2010to\u2010severe PCP in patients with human immunodeficiency virus infection"],"prefix":"10.1111","volume":"22","author":[{"given":"Q","family":"Tian","sequence":"first","affiliation":[{"name":"The Third People\u2019s Hospital of Guilin Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4540-6859","authenticated-orcid":false,"given":"J","family":"Si","sequence":"additional","affiliation":[{"name":"The First Hospital of Jiaxing Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Jiang","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Guilin Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Xu","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Guilin Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Wei","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Guilin Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Huang","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Guilin Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Q","family":"Li","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Guilin Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z","family":"Jiang","sequence":"additional","affiliation":[{"name":"People\u2019s Hospital of Liuzhou Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Zhao","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Guilin Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,12,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resinv.2019.01.009"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2017.1364991"},{"key":"e_1_2_7_4_1","unstructured":"Panel on Opportunistic Infections in HIV\u2010Infected Adults and Adolescents.Guidelines for the prevention and treatment of opportunistic infections in HIV\u2010infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention the National Institutes of Health and the HIV Medicine Association of the Infectious Diseases Society of America. Available at: https:\/\/aidsinfo.nih.gov\/guidelines [Accessed Date 10 January 2020]."},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc6806"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/crj.12042"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1130-1406(09)70004-X"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiu517"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0008524"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00017-11"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070619"},{"key":"e_1_2_7_12_1","first-page":"996","article-title":"Caspofungin in salvage treatment of severe pneumocystis pneumonia: case report and literature review","volume":"122","author":"Mu XD","year":"2009","journal-title":"Chin Med J"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/508282"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-016-0307-0"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002207"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmii.2016.03.008"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32834c4c3c"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.135350"},{"key":"e_1_2_7_19_1","first-page":"1594","article-title":"Efficacy of caspofungin combined with trimethoprim\/sulfamethoxazole as first\u2010line therapy to treat non\u2010HIV patients with severe pneumocystis pneumonia","volume":"15","author":"Zhang G","year":"2018","journal-title":"Exp Ther Med"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2019.08.015"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31816de84d"}],"container-title":["HIV Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.13013","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hiv.13013","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.13013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T11:00:00Z","timestamp":1693652400000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.13013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,4]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1111\/hiv.13013"],"URL":"https:\/\/doi.org\/10.1111\/hiv.13013","archive":["Portico"],"relation":{},"ISSN":["1464-2662","1468-1293"],"issn-type":[{"value":"1464-2662","type":"print"},{"value":"1468-1293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,4]]},"assertion":[{"value":"2020-10-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}