Zou Lun, Diao Yuting, Huang Zhihao, You Chunfang
Department of Infectious Diseases, Zigong First People's Hospital, Zigong, Sichuan, People's Republic of China.
Int Med Case Rep J. 2025 Aug 22;18:1071-1075. doi: 10.2147/IMCRJ.S537404. eCollection 2025.
Treating patients with human immunodeficiency virus (HIV) integrase strand transfer inhibitors (INSTIs) resistance and concurrent Talaromyces marneffei (T. marneffei) infection poses a significant clinical challenge, requiring precise antiretroviral adjustments, timely anti-infection, and management of complex drug interactions.
Interrupted antifungal therapy and INSTIs resistance in an HIV patient coinfected with T. marneffei resulted in severe immunosuppression. Initial voriconazole/imipenem treatment improved peritonitis. However, the symptoms recurred. Antiretroviral therapy (ART) was switched from elvitegravir to zidovudine, lamivudine, dolutegravir, and albuvirtide. Antifungal therapy adjusted from voriconazole to itraconazole. During the follow-up process, HIV RNA turned negative and the CD4 T cell count increased, but fungal antigens persisted until the 10-month follow-up period.
This case emphasizes genotype resistance testing-guided ART modification and rigorous opportunistic infection management in drug-resistant HIV patients. Coordinated care and timely interventions can enhance the outcomes in high-risk cases.
治疗对人类免疫缺陷病毒（HIV）整合酶链转移抑制剂（INSTIs）耐药且同时感染马尔尼菲篮状菌（T. marneffei）的患者面临重大临床挑战，需要精确调整抗逆转录病毒治疗、及时进行抗感染治疗以及处理复杂的药物相互作用。
一名同时感染马尔尼菲篮状菌的HIV患者中断抗真菌治疗且对INSTIs耐药，导致严重免疫抑制。初始伏立康唑/亚胺培南治疗改善了腹膜炎。然而，症状复发。抗逆转录病毒治疗（ART）从埃替格韦改为齐多夫定、拉米夫定、多替拉韦和阿巴卡韦。抗真菌治疗从伏立康唑调整为伊曲康唑。在随访过程中，HIV RNA转为阴性，CD4 T细胞计数增加，但真菌抗原一直持续到随访10个月时。
本病例强调在耐药HIV患者中进行基因型耐药检测指导的ART调整以及严格的机会性感染管理。协调护理和及时干预可改善高危病例的治疗结果。
