Pneumocystis carinii pneumonia (PCP) trends were examined in Houston/Harris County, Texas from 1988-2005. The incidence of PCP at AIDS diagnosis decreased significantly over this period, from over 60% in 1988 to 7.4% in 2005. Males were about 1.6 times more likely than females to be diagnosed with PCP. Although PCP diagnosis has decreased with increased access to healthcare and antiretroviral treatment, it remains a common AIDS-defining illness, especially in those not receiving treatment for HIV.