Abstract
ABSTRACT The dimorphic fungus Talaromyces marneffei (TM) is a common cause of HIV-associated opportunistic infections in Southeast Asia. Cotrimoxazole (CTX) inhibits folic acid synthesis which is important for the survival of many bacteria, protozoa, and fungi and has been used to prevent several opportunistic infections among HIV/AIDS patients. We question whether CTX is effective in preventing TM infection. To investigate this question, we conducted an 11-year (2005–2016) retrospective observational cohort study of all patients on the Chinese national antiretroviral therapy (ART) programme in Guangxi, a province with high HIV and TM burden in China. Survival analysis was conducted to investigate TM cumulative incidence, and Cox regression and propensity score matching (PSM) were used to evaluate the effect of CTX on TM incidence. Of the 3359 eligible individuals contributing 10,504.66 person-years of follow-up, 81.81% received CTX within 6 months after ART initiation, and 4.73% developed TM infection, contributing 15.14/1,000 person-year TM incidence rate. CTX patients had a significantly lower incidence of TM infection than non-CTX patients (4.11% vs. 7.53%; adjusted hazard ratio (aHR) = 0.50, 95% CI 0.35–0.73). CTX reduced TM incidence in all CD4+ cell subgroups (<50 cells/μL, 50–99 cells/μL, 100–199 cells/μL), with the highest reduction observed in patients with a baseline CD4+ cell count <50 cells/μL in both Cox regression and the PSM analyses. In conclusion, in addition to preventing other HIV-associated opportunistic infections, CTX prophylaxis has the potential to prevent TM infection in HIV/AIDS patients receiving ART.
Highlights
The human immunodeficiency virus (HIV) causes Acquired Immune Deficiency Syndrome (AIDS) which puts people at risk for opportunistic infections from pathogens that rarely affect healthy people, including Mycobacterium tuberculosis (MTB), Talaromyces marneffei (TM, previously known as Penicillium marneffei), Human Herpes Virus-8 (HHV-8, which causes Kaposi’s sarcoma), and Pneumocystis jiroveci [1]
A total of 5,596 HIV/AIDS patients who initiated antiretroviral therapy (ART) between April 2005 and June 2016 at the Fourth People’s Hospital of Nanning (FPHN) were screened for inclusion in the present study
A thorough evaluation of all environmental factors affecting TM incidence is not feasible for this study, we have addressed this issue by evaluating the distribution of the seasons when the TM cases were diagnosed for the CTX and non-CTX groups, and we found that the distributions of seasonality of TM diagnoses between CTX group and non-CTX group were not statistically different (Table S2), indicating that the seasonality does not affect the relationship of CTX use and reduced TM infection
Summary
The human immunodeficiency virus (HIV) causes Acquired Immune Deficiency Syndrome (AIDS) which puts people at risk for opportunistic infections from pathogens that rarely affect healthy people, including Mycobacterium tuberculosis (MTB), Talaromyces marneffei (TM, previously known as Penicillium marneffei), Human Herpes Virus-8 (HHV-8, which causes Kaposi’s sarcoma), and Pneumocystis jiroveci (which causes Pneumocystis joroveci pneumonia, PJP) [1]. Antiretroviral therapy (ART) suppresses HIV replication, restores immune function, and reduces the risk of opportunistic infections [2]. YL, JZ, WD, CL, HL, XL, JW and OZ were involved in the study supervision, data collection, and interpretation of the data. JH, HC, NZ, BL, CN and YL assisted with data management and data analysis. LT provided input in the revision edited the paper for English grammar. All authors contributed to the revision of the manuscript and approved the final version
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
