{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:19:20Z","timestamp":1792189160943,"version":"4.4.0"},"reference-count":59,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Immune reconstitution inflammatory syndrome (IRIS) can occur in patients with HIV after commencing antiretroviral therapy. Tuberculosis\u2013IRIS is the most common, and <jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia (PJP)\u2013IRIS accounts for only 2.7%\u20134% of IRIS cases. The prognosis and management of IRIS is well studied in other opportunistic infections but is ill defined for PJP\u2010IRIS, and no guidelines exist. We reviewed the literature to consolidate the available data for PJP\u2010IRIS to formulate recommendations for the diagnosis and management of this condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a literature review of cases of PJP\u2013IRIS and included cases in Australia that had not been previously published. We searched the Web of Science, MEDLINE, Embase, SCOPUS databases and grey literature sources for studies reporting cases of PJP\u2013IRIS between January 1981 and August 2024. We provide a synthesis of published cases evaluating pathogenesis, mortality, and therapeutic options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 51 patients were identified from 25 data sources. Two mortalities were described. We found that 22% of PJP\u2013IRIS cases required support in the intensive care unit. Antimicrobial treatment for PJP was given in 32 cases, and trimethoprim\u2013sulfamethoxazole was the most prescribed. Extending the duration of PJP therapy beyond the usual 21\u2009days did not appear to affect outcomes. Corticosteroids were given in 26 (52%) cases, not given in 12 cases (20%), and use was not stated in 13 cases (26%). The type and dose of steroid used varied and was described in 15 cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Mortality in PJP\u2013IRIS appears lower than in IRIS secondary to other opportunistic infections. Prompt treatment with corticosteroids at a dose proportionate to disease severity is recommended. Extending antimicrobials for PJP beyond 21\u2009days does not appear to offer clinical benefit in patients with PJP\u2013IRIS. With the rise of immunotherapy, new treatments could be on the horizon for PJP\u2013IRIS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.70016","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T22:52:08Z","timestamp":1743029528000},"page":"839-848","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["<scp><i>Pneumocystis jirovecii<\/i><\/scp> pneumonia\u2013Immune reconstitution inflammatory syndrome: A review of published cases"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0220-9249","authenticated-orcid":false,"given":"Natasha Marcella","family":"Vaselli","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Gold Coast University Hospital  Southport Queensland Australia"},{"name":"Institute of Infection, Veterinary &amp; Ecological Sciences University of Liverpool  Liverpool UK"},{"name":"NIHR Health Protection Research 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