Effects of cotrimoxazole prophylaxis on Talaromyces marneffei infection in HIV/ AIDS patients receiving antiretroviral therapy: a retrospective cohort study
Effects of cotrimoxazole prophylaxis on Talaromyces marneffei infection in HIV/ AIDS patients receiving antiretroviral therapy: a retrospective cohort study
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复方新诺明预防对接受抗逆转录病毒治疗的艾滋病毒/艾滋病患者马尔尼菲踝节菌感染的影响：一项回顾性队列研究
DOI：
10.1080/22221751.2019.1588078
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发表时间：
2019-03-11
影响因子：
13.2
通讯作者：
Liang, Hao
中科院分区：
文献类型：
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作者：
Jiang, Junjun;Qin, Fengxiang;Liang, Hao
在东南亚，二型真菌Talaromyces marneffei（TM）是HIV相关机会性感染的常见原因。复方新诺明（CTX）抑制叶酸合成，这对许多细菌，原生动物和真菌的生存很重要，并已被用于预防HIV/AIDS患者中的几种机会性感染。我们质疑CTX是否能有效预防TM感染。为了调查这个问题，我们对广西（中国HIV和TM负担高的省份）的中国国家抗逆转录病毒治疗（ART）项目的所有患者进行了一项为期11年（2005-2016年）的回顾性观察性队列研究。采用生存分析方法研究TM累积发生率，采用考克斯回归和倾向评分匹配（PSM）方法评价CTX对TM发生率的影响。在3359例符合条件的10504.66人-年随访中，81.81%的患者在ART开始后6个月内接受了CTX治疗，4.73%的患者发生了TM感染，TM发生率为15.14/1000人-年。CTX患者的TM感染发生率显著低于非CTX患者（4.11% vs. 7.53%;校正风险比（aHR）= 0.50，95% CI 0.35-0.73）。CTX降低了所有CD 4+细胞亚群的TM发病率（
The dimorphic fungus Talaromyces marneffei (TM) is a common cause of HIV-associated opportunistic infections in Southeast Asia. Cotrimoxazole (CTX) inhibits folk 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 (