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In the HAART era, Pneumocystis jirovecii Pneumonia (PJP) continues to be a major opportunistic infection. PJ PCR is increasingly available to support the diagnosis of PJP. A ‘low level’ PCR result may represent PJ colonisation or a poor-quality specimen. Upper airway samples such as throat swabs (T/S) are also more likely to yield a negative or low level positive. Method Retrospective review of all HIV-infected adults with respiratory tract PCR-confirmed PJP and pneumonia over an 18 month period. Demographics, clinical features, management, clinical outcome and laboratory parameters were recorded. Results 4/12 patients had negative T/S PJP PCR test before the diagnosis was confirmed. The mean cycle threshold (CT) value for throat swabs was 34.04. The mean CT value for sputum was 32.05. Discussion PJP PCR is a useful investigation. PCR will detect more cases than traditional tests (direct organism visualisation). This leads to earlier PJP treatment and earlier screening for HIV. While there is a trend towards lower CT value results in sputum when compared with throat swabs, any positive PJP result should trigger the offer of a HIV test. Patients with a negative URT PCR and clinical suspicion of PJP should receive empiric treatment and where appropriate proceed to BAL, as per national guidance.Abstract P089 Table 1 Patients with PJP (in order of immunosuppression) Age at HIV diagnosis, gender, behavioural risk Category CD4+ count at PJP diagnosis, PJP severity PJP test 1(Ct value, site) PJP test 2 (Ct value, site) Clinical outcome Known HIV 39/M/IDU On ART for 4 weeks, not on PJP prophylaxis 200, mild 37.0, TS n/a Survived 38/M/MSM Defaulted from care, not on ART 10, severe Neg., TS 32.5, TS ICU care, survived Missed opportunity to diagnose HIV 53/M/MSM Unexplained diarrhoea and weight loss 70, severe 30.0, SPU 26.2, SPU ICU care, deceased 43/F/heterosexual Unexplained lymphadenopathy and weight loss 50, severe 26.4, SPU Neg., TS Readmitted with hypoxia, survived 32/F/heterosexual Campylobacter gastroenteritis 50, severe 36.4, TS 25.3, SPU ICU care, survived 56/M/unknown – 30, severe Neg., TS 31.5, SPU ICU care, deceased 39/M/heterosexual Unexplained weight loss 20, mild Neg., TS 25.0, SPU Survived 62/M/MSM Unexplained weight loss 20, mild 26.0, BAL n/a Survived 55/M/MSM Bacterial pneumonia 20, mild 33.0, SPU n/a Survived 52/M/heterosexual – 10, severe 30.3, SPU 34.9, SPU ICU care, survived 57/M/MSM Unexplained weight loss 10, severe 39.0, SPU n/a ICU care, survived 52/M/heterosexual Chronic diarrhoea, bacterial pneumonia 0, severe Neg., SPU 28.0, SPU ICU care, hypoxia requiring long-term home-O2 Note- BAL broncho-alveolar lavage; F: female; M: male; ICU: intensive care unit; IDU: intravenous drug user; MSM men who have sex with men; n/a: not available; Neg.: PCR not detected; SPU: sputum, TS: throat swab PJP severity (‘mild’: mild-moderate, or ‘severe’: moderate-severe, by BHIVA criteria)

P089 PJP diagnosis in the haart & PCR era