What is the current incidence of PcP in HIV-infected populations?

1. What is the incidence in high-income countries, including the US and Western Europe, where access to combination antiretroviral therapy is generally widely available?

   1. In these countries, which populations continue to develop PcP?

   2. Strategies to identify persons at risk for HIV and PcP need to be refined and preventative measures need to be implemented.

2. What is the incidence in low- and middle-income countries, where access to combination antiretroviral therapy is generally more limited?

   1. In these countries, which populations develop PcP?

   2. Strategies to identify persons at risk for HIV and PcP need to be refined and preventative measures need to be implemented.

   3. Efforts to improve diagnostic and microbiologic capacity are needed.

   4. Surveillance networks to track PcP cases should be developed.

What is the current incidence of PcP in non-HIV, immunocompromised populations?

1. What is the incidence in populations immunocompromised from “traditional” immunosuppressive agents (e.g., glucocorticoid medications) and disease therapies (e.g., therapies for hematologic malignancy and cancer and after hematopoietic stemb.

2. What is the incidence in populations immunocompromised from “newer” biologic, immunomodulating agents (e.g., tumornecrosis factor-alpha inhibitors)?

3. Surveillance networks to track PcP cases should be developed.

What is the optimum approach to the diagnosis of PcP?

1. Bronchoscopy with bronchoalveolar lavage (BAL)?

2. Sputum induction (SI), followed by BAL, if SI is negative?

Is there a role for non-invasive tests in PcP diagnosis?

1. Oropharyngeal washing (OPW): Which specimen? Which assay? Which protocol?

2. Plasma s-adenosylmethionine?

3. (1-3)-beta-D-glucan?

4. Is the diagnostic accuracy different in non-HIV populations (lower Pneumocystis burden)?

New drugs to treat and prevent PcP are needed.

What is the optimum second-line treatment for PcP?

1. Prospective, randomized clinical trials are needed.

Does TMP-SMX drug resistance exist?

1. What is (are) the mechanisms?

   1. Dihydropteroate synthase (DHPS) gene mutations?

   2. Dihydrofolate reductase (DHFR) gene mutations?

   3. Sub-therapeutic trimethoprim or sulfamethoxazole drug levels?

   4. Host factors?

What is the optimal timing for initiation of ART in HIV-associated PcP?

1. In Intensive care unit (ICU)?

2. Outside of the ICU?

What is the incidence of PcP-IRIS?

1. What are the risk factors?

2. Can PcP-IRIS be prevented (prophylaxis)?

What are the implications of Pneumocystis colonization for the colonized individual?

1. COPD?

2. Other pulmonary diseases?

Can persons colonized with Pneumocystis transmit infection to others?

1. Risk factors for transmission – source, environment, contact.