Comprehensive Pathogen Spectrum Analysis Using mNGS in AIDS Patients With Pulmonary Infections: Diagnostic Value and Clinical Implications.

BACKGROUND: This study evaluated the diagnostic value of metagenomic next-generation sequencing (mNGS) in identifying pathogens causing pulmonary infections in 64 acquired immunodeficiency syndrome (AIDS) patients at Beijing Ditan Hospital. METHODS: Bronchoalveolar lavage fluid (BALF) samples were analyzed using mNGS and conventional microbiological tests (CMT). Diagnostic performance was compared, and random forest analysis was used to assess pathogenicity. RESULTS: mNGS detected 45 pathogens, including 14 viruses, 3 fungi, and 28 bacteria. Compared with CMT, mNGS showed higher sensitivity for detecting bacteria (75.0% vs 29.17%), fungi (45.0% vs 16.67%), and viruses (80.0% vs 20.83%). Mixed infections were identified in 55.2% of cases, predominantly Pneumocystis pneumonia (PCP) with bacterial coinfections. However, mNGS had lower concordance with CMT for viruses (24.1% for cytomegalovirus) and Mycobacterium tuberculosis (75.0%). Random forest analysis highlighted Candida albicans and Stenotrophomonas maltophilia as highly pathogenic. CONCLUSIONS: While mNGS demonstrated superior broad-spectrum detection, its limitations in viral and TB diagnosis underscore the need for optimized protocols. The study supports mNGS as a complementary tool for diagnosing complex pulmonary infections in AIDS patients, enhancing precision medicine but requiring further refinement for widespread clinical adoption.