Voriconazole Versus Amphotericin B as Induction Therapy for Talaromycosis in HIV/AIDS Patients: A Retrospective Study
Voriconazole Versus Amphotericin B as Induction Therapy for Talaromycosis in HIV/AIDS Patients: A Retrospective Study
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DOI：
10.1007/s11046-021-00533-5
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发表时间：
2021-02-22
期刊：
影响因子：
5.5
通讯作者：
Jiang, Jianning
中科院分区：
文献类型：
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作者：
Huang, Weie;Li, Tiantian;Jiang, Jianning
由马尔尼菲踝节菌引起的播散性踝节菌病是一种危及生命的机会性感染。虽然阿替西霉素B脱氧胆酸盐（dAm B）仍然是一线诱导治疗，但也可以使用伏立康唑。然而，尚无临床试验比较dAmB和伏立康唑在足癣治疗中的作用。我们回顾性评价了伏立康唑或dAmB作为HIV感染患者足癣菌病诱导治疗的有效性和安全性。我们招募了确诊为马尔尼菲篮状菌感染的HIV感染患者，这些患者接受静脉注射dAmB（0.6至0.7 mg/kg，每日一次，持续2周）或伏立康唑（第1天每12 h 6 mg/kg，之后每12 h 4 mg/kg）作为诱导治疗，随后口服伊曲康唑作为巩固和维持治疗。根据有效率评价药物疗效。根据不良事件的发生情况评价药物安全性。总共有58名接受伏立康唑的患者和82名接受dAmB的患者从两家医院入组。伏立康唑和dAmB治疗组在主要和随访疗效评价时的应答率相似。然而，伏立康唑组患者诱导抗真菌治疗的持续时间和住院时间均短于dAmB组。伏立康唑组和dAmB组均未发生不良反应。我们的回顾性研究表明，伏立康唑是一种有效和安全的诱导抗真菌药物治疗HIV相关的播散性足癣菌病。伏立康唑诱导治疗的持续时间较短，表明其可能是临床实践中更好的选择。伏立康唑诱导治疗的持续时间为11至13天。
Disseminated talaromycosis caused by Talaromyces marneffei is a life-threatening opportunistic infection. Although amphotericin B deoxycholate (dAmB) remains the first-line induction treatment, voriconazole can also be used. However, no clinical trials have compared dAmB and voriconazole in the administration of talaromycosis. We retrospectively evaluated the efficacy and safety of voriconazole or dAmB as induction therapy for talaromycosis in HIV-infected patients. We enrolled HIV-infected patients with a confirmed Talaromyces marneffei infection who received intravenous dAmB (0.6 to 0.7 mg/kg daily for 2 weeks) or voriconazole (6 mg/kg every 12 h on day 1 and 4 mg/kg every 12 h afterward) as induction therapy, followed by oral itraconazole as consolidation and maintenance therapy. Drug efficacy was evaluated based on response rate. Drug safety was evaluated based on the occurrence of adverse events. In total, 58 patients who received voriconazole and 82 who received dAmB were enrolled from two hospitals. The voriconazole and dAmB treatment groups had similar response rates at the primary and follow-up efficacy evaluations. However, the durations of induction antifungal therapy and hospital stay were shorter for patients in the voriconazole group than in the dAmB group. Few adverse reactions occurred in either the voriconazole or dAmB group. Our retrospective study indicated that voriconazole is an effective and safe induction antifungal drug for HIV-associated disseminated talaromycosis. The duration of induction treatment with voriconazole was shorter, indicating its potential as a better choice in clinical practice. The duration of voriconazole induction therapy is 11 to 13 days.