Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China.
Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.
J Infect. 2022 Mar;84(3):410-417. doi: 10.1016/j.jinf.2021.12.032. Epub 2021 Dec 25.
No current academic data is available with respect to the optimal timing to initiate antiretroviral therapy (ART) in HIV-positive patients with talaromycosis. Our study aimed to evaluate the optimal timing of ART initiation for patients presenting with AIDS-related talaromycosis.
In this prospective, randomized, open-label multicenter trial, 228 patients from 15 hospitals in China were randomly assigned to an early ART group (initiation of ART within 2 weeks after randomization) and a deferred ART group (initiation of ART 2 weeks after randomization). The primary endpoint was all-cause mortality during the 48 weeks after randomization.
We observed a significant difference in mortality between the early ART group and the deferred ART group (2.2% vs. 8.9%, 95%CI: -0.15 to 14.05, p = 0.049). The composite outcome of AIDS-defining events or death in the early ART group was found to be lower than that in the deferred ART group (3.3% vs. 14.9%; 95%CI: 2.93 to 19.23, p = 0.008).
The prognosis of HIV-infected patients with talaromycosis in the early ART group was more favorable than that of patients in the deferred ART group. These results demonstrate that early ART initiation should be considered in HIV-infected patients with talaromycosis .
目前尚无关于 HIV 阳性患者感染足放线病菌后启动抗逆转录病毒治疗（ART）的最佳时机的学术数据。本研究旨在评估 AIDS 相关足放线病菌感染患者启动 ART 的最佳时机。
在这项前瞻性、随机、开放标签的多中心试验中，来自中国 15 家医院的 228 名患者被随机分配到早期 ART 组（随机分组后 2 周内开始 ART）和延迟 ART 组（随机分组后 2 周开始 ART）。主要终点是随机分组后 48 周内的全因死亡率。
我们观察到早期 ART 组和延迟 ART 组之间死亡率存在显著差异（2.2%对 8.9%，95%CI：-0.15 至 14.05，p=0.049）。早期 ART 组的 AIDS 定义事件或死亡复合结局低于延迟 ART 组（3.3%对 14.9%；95%CI：2.93 至 19.23，p=0.008）。
早期 ART 组 HIV 感染合并足放线病菌感染患者的预后好于延迟 ART 组。这些结果表明，对于 HIV 感染合并足放线病菌感染的患者，应考虑早期启动 ART。
