Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study.
<h4>Background</h4>The optimal initial induction treatment for HIV-associated Talaromyces marneffei fungemia (HTMF) remains unclear.<h4>Methods</h4>Three hundred and fifteen patients with HIV-associated Talaromyces marneffei were enrolled in this multicenter retrospective stu...
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Public Library of Science (PLoS)
2025-04-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0013012 |
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| author | Shasha Ye Jiaying Qin Xingguo Miao Guanjing Lang Mengyan Wang Gong Chen Feifei Su Lijun Xu |
| author_facet | Shasha Ye Jiaying Qin Xingguo Miao Guanjing Lang Mengyan Wang Gong Chen Feifei Su Lijun Xu |
| author_sort | Shasha Ye |
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| description | <h4>Background</h4>The optimal initial induction treatment for HIV-associated Talaromyces marneffei fungemia (HTMF) remains unclear.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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. |
| format | Article |
| id | doaj-art-40f37de4e4ef4281bf3a1733d537fd81 |
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| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-40f37de4e4ef4281bf3a1733d537fd812025-08-20T02:36:15ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352025-04-01194e001301210.1371/journal.pntd.0013012Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study.Shasha YeJiaying QinXingguo MiaoGuanjing LangMengyan WangGong ChenFeifei SuLijun Xu<h4>Background</h4>The optimal initial induction treatment for HIV-associated Talaromyces marneffei fungemia (HTMF) remains unclear.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.https://doi.org/10.1371/journal.pntd.0013012 |
| spellingShingle | Shasha Ye Jiaying Qin Xingguo Miao Guanjing Lang Mengyan Wang Gong Chen Feifei Su Lijun Xu Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study. PLoS Neglected Tropical Diseases |
| title | Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study. |
| title_full | Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study. |
| title_fullStr | Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study. |
| title_full_unstemmed | Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study. |
| title_short | Voriconazole is inferior to amphotericin B deoxycholate as the initial induction therapy for HIV-associated Talaromyces marneffei fungemia: A multicenter retrospective study. |
| title_sort | voriconazole is inferior to amphotericin b deoxycholate as the initial induction therapy for hiv associated talaromyces marneffei fungemia a multicenter retrospective study |
| url | https://doi.org/10.1371/journal.pntd.0013012 |
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