The role of corticosteroids in management of non-HIV immunocompromised patients hospitalized for Pneumocystis jirovecii pneumonia.

INTRODUCTION: Caused by pneumocystis jirovecii, pneumocystosis is a severe opportunistic infection primarily affecting immunocompromised patients who are not infected with HIV. Mortality in this heterogeneous population is high, with estimates ranging from 25% to 50%. While the benefits of corticosteroids for HIV-infected patients are well-established, in other immunosuppression contexts their role remains uncertain, with contradictory results reported in the literature. PATIENTS AND METHODS: This single-center retrospective study included 101 non-HIV immunocompromised patients hospitalized at Caen University Hospital between 2013 and 2024 for proven or probable pneumocystosis. RESULTS: Thirty-nine patients received adjunctive corticosteroid therapy. Thirty-day mortality was 26% in the corticosteroid group versus 18% in the non-corticosteroid group, with no significant difference after adjustment. Similarly, no benefit was observed at 90 days or at one year. Nor did corticosteroid therapy reduce the duration of oxygen therapy, affect the incidence of secondary infections or, more generally, emerge as protective. Conversely, the factors associated with higher survival rates were admission to conventional care units and younger age. CONCLUSION: In contrast with HIV settings, this study does not show corticosteroid therapy to be beneficial for non-HIV patients with pneumocystosis,. However, recent data from the PIC trial suggest potentially improved benefit 90-day survival in the most severe forms; further targeted studies consequently appear justified, particularly with regard to immunodeficiency subtypes.