HIV-associated talaromycosis: Does timing of antiretroviral therapy matter?

Qin, Yuanyuan; Zhou, Yihong; Liu, Songtao; Lu, Yanqiu; Liu, Min; Yuan, Jing; Nie, Jingmin; Ouyang, Jing; Wu, Hao; Qin, Yingmei; Jiang, Zhuocheng; Zhou, Guoqiang; Tian, Qun; Lan, Ke; Zhou, Yang; Yang, Xiuwen; He, Kaiyin; Liu, Jun; Harypursat, Vijay; Chen, Yaokai

doi:10.1016/j.jinf.2021.12.032

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…In 2021, one multicenter randomized controlled study from China evaluated the optimal timing of ART initiation for patients presenting with AIDS-related talaromycosis. A significantly lower mortality rate during the 48 weeks was observed in the early ART group (the median period from antifungal therapy to ART initiation was 11 days) when compared to the deferred ART group (the median period from antifungal therapy to ART initiation was 21 days) [29] …”

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confidence: 84%

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confidence: 99%

“…A significantly lower mortality rate during the 48 weeks was observed in the early ART group (the median period from antifungal therapy to ART initiation was 11 days) when compared to the deferred ART group (the median period from antifungal therapy to ART initiation was 21 days). [29] Talaromycosis has been continuously threatening immunodeficient patients globally, urgently requiring rapid diagnostic and more effective treatment methods. MALDI-TOF MS, Mp1p antigen detection, and mNGS have been shown to have the potential for early diagnosis.…”

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confidence: 99%

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Advances in diagnosis and treatment of talaromycosis in patients with AIDS

Guo

Tang

2022

Chinese Medical Journal

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confidence: 84%

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confidence: 99%

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confidence: 99%

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Advances in diagnosis and treatment of talaromycosis in patients with AIDS

Guo

Tang

2022

Chinese Medical Journal

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“…[2] As is well known, timely ART initiation is crucial for patients with HIV with opportunistic infections as the immunity of such patients is severely compromised and requires immediate reconstitution. [3][4][5][6] However, overlapping drug toxicities, potential pharmacokinetic interactions with ART drugs, and the emergence of immune reconstitution inflammatory syndrome (IRIS) may occur when ART is initiated early, thus possibly leading to poorer outcomes. Meanwhile, if ART is deferred, the already severely compromised immunity will also lead to poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

Optimal Timing of Antiretroviral Therapy Initiation in Acquired Immunodeficiency Syndrome–Associated Toxoplasmic Encephalitis: A Prospective Observational Multicenter Study in China

Li,

Jiang,

Zeng

et al. 2024

Infect Dis Immun

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Background Toxoplasmic encephalitis (TE) is the most frequent cause of expansive brain lesions among patients with acquired immunodeficiency syndrome (AIDS). However, the optimal timing of antiretroviral therapy (ART) initiation in these patients remains controversial. This study aims to investigate the differences in outcomes of ART initiation at different times, in order to help clarify the treatment timing of AIDS-associated TE. Methods This multicenter prospective observational study included 87 patients recruited from 11 research centers in China (from March 2019 to December 2022). Of the patients, 38 were assigned to the early ART group (initiating ART within 2 weeks after anti-Toxoplasma treatment initiation), and the remaining 49 patients received deferred ART (initiating ART at least 2 weeks after anti-Toxoplasma treatment initiation). The main outcomes included mortality and emergence of immune reconstitution inflammatory syndrome (IRIS). Human immunodeficiency virus (HIV)-1 viral load and CD4+ T-cell counts at weeks 24 and 48 were observed. Results The number of deaths (1 vs. 5, P = 0.225) and incidence of IRIS (2.6% vs. 0, P = 0.437) were not significantly different between the early and deferred ART groups at week 48. Early ART initiation did not contribute significantly to HIV-1 viral load control (<50 copies/mL, n = 8 vs. n = 3 at week 24, P = 0.142; n = 7 vs. n = 7 at week 48, P = 1.000). The median CD4+ T-cell counts between the two groups were not significantly different, either at week 24 (155 vs. 91 cells/mm3, P = 0.837) or at week 48 (181 vs. 146 cells/mm3, P = 0.219). Conclusion In patients with AIDS-associated TE, early ART initiation was not significantly different from deferred ART initiation in terms of incidence of mortality, IRIS, and HIV virological and immunological outcomes. Trial registration: This study was registered (registration number: ChiCTR1900021195) as one of 12 clinical trials under the title of a general project at the Chinese Clinical Trial Registry (chictr.gov) on February 1, 2019. Enrollment for this study began in March 2019.

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“…Even with ART treatment, the mortality rate of the T.marneffei infection can still reach 33% in China ( 15 ). Given the high fatality rate, timely diagnosis and treatment are crucial for HIV patients ( 16 ). In the current times, the most accurate diagnosis is the microscopic identification of morphological and dimorphic fungi separated and cultured from clinical specimens ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound characterization of superficial lymph nodes in HIV patients with Talaromyces marneffei infection

Pan,

Shao

2023

Front. Med.

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ObjectivesThis study aimed at exploring the ultrasound characteristics of superficial lymph nodes (LNs) in HIV patients with Talaromyces marneffei infection to provide assistance and understanding for diagnosis and therapy.MethodsA retrospective analysis was conducted on 26 patients with confirmed HIV and T.marneffei coinfection. These patients underwent ultrasound examination and ultrasound-guided puncture biopsies at our hospital from March 2015 to March 2023.ResultsIn all 26 patients, lymphadenectasis was observed. Among the 21 cases (80.76%), LNs showed a diffusely hyperechoic appearance with a tulle-like change, and 6 cases (23.07%) showed liquefaction. When the hila were present or thinned, the blood flow signals were primarily hilar, whether rich or poor, and when the hila were absent, the blood flow signals were peripheral or poor. The axillary LN long-to-short diameter (L/S) ratios exhibited a significant positive correlation with CD4+T cell counts (r = 0.8214, p = 0.0341). Patients with retroperitoneal lymphadenectasis showed decreased NK cell counts (p = 0.03).ConclusionIn summary, the T.marneffei infection of LNs in HIV patients often manifests with superficial LN enlargement, mostly affecting the cervical LNs. The T.marneffei-infected LNs exhibit several characteristics such as echogenicity, hilum, and blood flow signal. Furthermore, there might be associations between lymphocyte subsets and enlarged superficial LNs. Ultrasound examinations should be paid attention to if patients have superficial LN enlargement, and the diagnosis of the T.marneffei infection is considered.

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HIV-associated talaromycosis: Does timing of antiretroviral therapy matter?

Cited by 10 publications

References 16 publications

Advances in diagnosis and treatment of talaromycosis in patients with AIDS

Advances in diagnosis and treatment of talaromycosis in patients with AIDS

Optimal Timing of Antiretroviral Therapy Initiation in Acquired Immunodeficiency Syndrome–Associated Toxoplasmic Encephalitis: A Prospective Observational Multicenter Study in China

Ultrasound characterization of superficial lymph nodes in HIV patients with Talaromyces marneffei infection

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