PCP prophylaxis is necessary for non-HIV patients with specific immunosuppressive conditions

Johan Maertens, Simone Cesaro, Georg Maschmeyer, Hermann Einsele, J. Peter Donnelly, Alexandre Alanio, Philippe M. Hauser, Katrien Lagrou, Willem J. G. Melchers, Jannik Helweg‐Larsen, Olga Matos, Stéphane Bretagne, Catherine Cordonnier. ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. 2016. https://doi.org/10.1093/jac/dkw157

ECIL guidelines establish clear indications and drug-of-choice recommendations for primary PCP prophylaxis in high-risk hematological and transplant patient groups.

Rishma Maini, Katherine L. Henderson, Elizabeth Sheridan, Theresa Lamagni, Gordon Nichols, Valérie Delpech, Nick Phin. Increasing<i>Pneumocystis</i>Pneumonia, England, UK, 2000–2010. 2013. https://doi.org/10.3201/eid1903.121151

Population-based studies confirm rising PCP incidence among non-HIV groups such as transplant recipients and those with hematologic malignancies, underscoring prevention needs.

Magdalena Sokulska, Marta Kicia, Maria Wesołowska, Andrzej B. Hendrich. Pneumocystis jirovecii—from a commensal to pathogen: clinical and diagnostic review. 2015. https://doi.org/10.1007/s00436-015-4678-6

Clinical reviews highlight that PCP remains a significant cause of high mortality in non-HIV immunosuppressed hosts, necessitating careful management.

Albert Dunbar, Alexander Schauwvlieghe, Sheruna Algoe, Jaap J. van Hellemond, Marijke Reynders, Stefaan J. Vandecasteele, Jerina Boelens, Pieter Depuydt, Bart Rijnders. Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis. 2020. https://doi.org/10.3389/fcimb.2020.00224

Retrospective data show that most non-HIV patients who develop PCP had clear guideline indications for prophylaxis that were unfulfilled prior to infection.

Léo Sauvat, Laure Denis, Céline Nourrisson, Philippe Poirier, Marc Ruivard, Guillaume Le Guenno. Pneumocystis jirovecii pneumonia in non-HIV patients: need for a more extended prophylaxis. 2024. https://doi.org/10.3389/fmed.2024.1414092

Analysis of non-HIV PCP cohorts emphasizes that a substantial proportion of patients meeting criteria for prophylaxis did not receive it, pointing to a need for better adherence.

Pulsipher AM, Zhou K, Henry KJ, Rusk AM, Gotway MB, Limper AH, Cartin-Ceba R, Vikram HR, Ham K. Pneumocystis jirovecii pneumonia in solid tumors: High mortality amid frequent corticosteroid exposure and infrequent prophylaxis.. 2026. https://doi.org/10.1016/j.rmed.2026.109049

Studies in solid tumor patients demonstrate high mortality associated with PCP and chronic corticosteroid exposure, highlighting underutilized preventive care.

Chastain DB, Solorzano-Salazar DM, Mantha A, Van Hook R, Maloney J, Thompson GR 3rd, Chiu CY, Shapiro L, Brown N, Henao-Martínez AF. &lt;i&gt;Pneumocystis jirovecii&lt;/i&gt; Pneumonia in Non-HIV, Non-HCT Adults: Real-World Patterns of Overlapping Immunosuppression and PJP-Active Therapy.. 2026. https://doi.org/10.1177/10600280261443794

Real-world data indicate that non-HIV patients frequently experience overlapping immunosuppressive exposures, supporting targeted prophylaxis based on overall immunologic burden.