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Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study
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 ma...
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| Format: | Thesis |
| Language: | English English |
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Department of Medicine
2025
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| _version_ | 1867613310878220288 |
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| access_status_str | Open Access |
| author | Wills, Nicola |
| author2 | Wasserman, Sean |
| author_browse | Wasserman, Sean Wills, Nicola |
| author_facet | Wasserman, Sean Wills, Nicola |
| author_sort | Wills, Nicola |
| collection | Thesis |
| description | 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. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/41979 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:34:06.076Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/41979 Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study Wills, Nicola Wasserman, Sean X-ray HIV 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. 2025-10-02T11:56:59Z 2025-10-02T11:56:59Z 2025 2025-10-02T11:35:05Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/41979 en eng application/pdf Department of Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | X-ray HIV Wills, Nicola Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study |
| thesis_degree_str | Master's |
| title | Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study |
| title_full | Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study |
| title_fullStr | Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study |
| title_full_unstemmed | Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study |
| title_short | Radiological predictors of PCP in HIV-positive adults in South Africa: a matched case-control study |
| title_sort | radiological predictors of pcp in hiv positive adults in south africa a matched case control study |
| topic | X-ray HIV |
| url | http://hdl.handle.net/11427/41979 |
| work_keys_str_mv | AT willsnicola radiologicalpredictorsofpcpinhivpositiveadultsinsouthafricaamatchedcasecontrolstudy |