Ye Shasha, Qin Jiaying, Miao Xingguo, Lang Guanjing, Wang Mengyan, Chen Gong, Su Feifei, Xu Lijun
National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
PLoS Negl Trop Dis. 2025 Apr 8;19(4):e0013012. doi: 10.1371/journal.pntd.0013012. eCollection 2025 Apr.
The optimal initial induction treatment for HIV-associated Talaromyces marneffei fungemia (HTMF) remains unclear.
Three hundred and fifteen patients with HIV-associated Talaromyces marneffei were enrolled in this multicenter retrospective study. The effectiveness of induction regimens with amphotericin B deoxycholate (iAmBd), voriconazole (iVori), and a switch regimen from iVori to AmBd (iVori→AmBd switch) on 180-day all-cause mortality in HTMF patients was assessed.
The prevalence of HTMF was 75.9% (239/315) with a 180-day all-cause mortality of 20.1% (48/239). Among these HTMF patients, 44.4% (106/239) were treated with iAmBd, 41.8% (100/239) with iVori, and 13.8% (33/239) with other regimens. Additionally, 53% (53/100) of patients treated with iVori underwent an iVori→AmBd switch within 7 days. The 180-day cumulative survival rates were 88.7% for patients treated with iAmBd and 77.0% for those treated with iVori; 88.8% for patients who received AmBd within 3 days (iAmBd + 3-day iVori→AmBd switch) and 72.2% for those who continued iVori; 88.2% for patients who received AmBd within 5 days (iAmBd + 5-day iVori→AmBd switch) and 71.0% for those who continued iVori; 88.1% for those who received AmBd within 7 days (iAmBd + 7-day iVori→AmBd switch) and 66.0% for those who continued iVori (all log-rank P < 0.020). The prevalence of adverse drug reactions (ADRs) was 24.5% in the iAmBd group and 9.0% in the iVori group in induction stage (P < 0.001).
Voriconazole is inferior to AmBd as an initial induction therapy for HTMF patients. Early AmBd administration or an early iVori→AmBd switch improves survival, despite the higher incidence of AmBd-related ADRs.
HIV 相关马尔尼菲篮状菌血症（HTMF）的最佳初始诱导治疗方案仍不明确。
315 例 HIV 相关马尔尼菲篮状菌血症患者纳入了这项多中心回顾性研究。评估了去氧胆酸两性霉素 B（iAmBd）、伏立康唑（iVori）以及从 iVori 转换为 AmBd 的转换方案（iVori→AmBd 转换）诱导方案对 HTMF 患者 180 天全因死亡率的有效性。
HTMF 的患病率为 75.9%（239/315），180 天全因死亡率为 20.1%（48/239）。在这些 HTMF 患者中，44.4%（106/239）接受 iAmBd 治疗，41.8%（100/239）接受 iVori 治疗，13.8%（33/239）接受其他方案治疗。此外，接受 iVori 治疗的患者中有 53%（53/100）在 7 天内进行了 iVori→AmBd 转换。接受 iAmBd 治疗的患者 180 天累积生存率为 88.7%，接受 iVori 治疗的患者为 77.0%；在 3 天内接受 AmBd 的患者（iAmBd + 3 天 iVori→AmBd 转换）为 88.8%，继续使用 iVori 的患者为 72.2%；在 5 天内接受 AmBd 的患者（iAmBd + 5 天 iVori→AmBd 转换）为 88.2%，继续使用 iVori 的患者为 71.0%；在 7 天内接受 AmBd 的患者（iAmBd + 7 天 iVori→AmBd 转换）为 88.1%，继续使用 iVori 的患者为 66.0%（所有对数秩检验 P < 0.020）。诱导期不良反应（ADR）的发生率在 iAmBd 组为 24.5%，在 iVori 组为 9.0%（P < 0.001）。
对于 HTMF 患者，伏立康唑作为初始诱导治疗不如两性霉素 B。早期给予两性霉素 B 或早期 iVori→AmBd 转换可提高生存率，尽管与两性霉素 B 相关的不良反应发生率较高。
