Editor’s Note: Talaromyces marneffei (TM) is a thermal dimorphic fungus that can cause systemic fungal infections in humans. This fungal infection is common in immunocompromised individuals and is one of the leading causes of death among HIV/AIDS patients in Southeast Asia and South Asia. At the 19th European AIDS Conference (EACS) held from October 18 to 21, 2023, Professor Chen Yaokai and his team from the Chongqing Public Health Medical Treatment Center presented a research report titled “Severe Anemia, Severe Leukopenia, and Severe Thrombocytopenia in HIV-Related Talaromyces Marneffei Infection Induced by Amphotericin B Deoxycholate: A Secondary Analysis of a Prospective Multicenter Cohort Study.” This study contributes to global efforts to combat the HIV epidemic and co-infections by presenting findings from China. Below is a summary of their research.
Research Introduction
This study aimed to explore the predictive factors for severe anemia, severe leukopenia, and severe thrombocytopenia in HIV-infected patients co-infected with Talaromyces marneffei (TM) and treated with amphotericin B deoxycholate induction therapy. The study included 170 HIV-infected patients with TM co-infection between January 1, 2019, and September 30, 2020.
Research Findings
Approximately 42.9%, 20.6%, and 10.6% of the eligible patients experienced severe anemia, severe leukopenia, and severe thrombocytopenia, respectively.
▌ Baseline hemoglobin levels <100 g/L (OR=5.846, 95% CI: 2.765–12.363), serum creatinine levels >73.4 μmol/L (OR=2.573, 95% CI: 1.157–5.723), aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratio >1.6 (OR=2.479, 95% CI: 1.167–5.266), sodium levels ≤136 mmol/L (OR=4.342, 95% CI: 1.747–10.789), and amphotericin B deoxycholate dosage >0.58 mg/(kg·d) (OR=2.504, 95% CI: 1.066–5.882) were identified as independent risk factors for severe anemia.
▌ Co-infection with pulmonary tuberculosis (OR=3.307, 95% CI: 1.050–10.420) and platelet levels (per 10×109/L) (OR=0.952, 95% CI: 0.911–0.996) were identified as independent risk factors for severe leukopenia.
▌ Platelet levels <100×109/L (OR=2.935, 95% CI: 1.075–8.016) were determined as an independent risk factor for severe thrombocytopenia.
There was no difference in the progression to severe anemia, severe leukopenia, and severe thrombocytopenia between the survival group and the death group. The presence or absence of fungal clearance at 2 weeks also showed no difference in these aspects.
Table 1. Relationship Between Progression to Severe Anemia, Severe Leukopenia, and Severe Thrombocytopenia Within 2 Weeks and Death and Fungal Clearance
Compared to the group receiving 5 mg of amphotericin B deoxycholate on the first day, the group receiving 10 mg on the first day was an independent risk factor for progression to severe anemia (OR=2.621, 95% CI: 1.107–6.206).
Table 2. Univariate Analysis of Factors Leading to Severe Anemia, Severe Leukopenia, and Severe Thrombocytopenia in 149 Patients
The amphotericin B deoxycholate starting dose at 10 mg daily had the highest fungal clearance rate of 96.3%, significantly better than the groups with starting doses of 5 mg, 10 mg, and 20 mg daily (60.9%) and 5 mg, 15 mg, and 25 mg daily (62.9%).
Table 3. Results of Three Amphotericin B Starting Regimens in 149 Patients at 2 and 48 Weeks
Conclusion of the Study
The findings above reveal the risk factors for HIV patients co-infected with Talaromyces marneffei (TM) progressing to severe anemia, severe leukopenia, and severe thrombocytopenia after receiving amphotericin B treatment. These severe adverse events may not be related to fungal clearance at 2 weeks. Starting amphotericin B deoxycholate at a dose of 10 mg on the first day may increase the risk of severe anemia but is more favorable for early fungal clearance.
Professor Chen Yaokai
Director, Department of Infectious Diseases, Chongqing Public Health Medical Treatment Center / Affiliated Public Health Hospital of Southwest University
