Effects of Talaromyces marneffei infection on mortality of HIV/AIDS patients in southern China: a retrospective cohort study
Effects of Talaromyces marneffei infection on mortality of HIV/AIDS patients in southern China: a retrospective cohort study
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马尔尼菲踝节菌感染对中国南方艾滋病毒/艾滋病患者死亡率的影响：一项回顾性队列研究
DOI：
10.1016/j.cmi.2018.04.018
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发表时间：
2019-02-01
影响因子：
14.2
通讯作者：
Liang, H.
中科院分区：
文献类型：
--
作者：
Jiang, J.;Meng, S.;Liang, H.
目的：马尔尼菲塔拉霉菌是东南亚和中国南部地区人类免疫缺陷病毒/艾滋病患者中发病率较高的一种机会性感染。其对HIV/AIDS患者死亡率的影响尚不清楚。方法：对2012年至2015年在广西南宁市第四人民医院住院的HIV感染者进行回顾性队列研究，中国。采用Kaplan-Meier分析计算累积死亡率。结果：共纳入6791例HIV/AIDS患者，其中1093例(16.1%)合并感染马尔尼菲毛滴虫。感染马尔尼菲毛滴虫患者的死亡率(25.0/百人月，95%可信区间21.5~26.7)最高，显著高于未感染马尔尼菲毛滴虫的HIV/AIDS患者(13.8/百人月，95%可信区间12.5~15.1；调整危险比(AHR)1.80，95%可信区间1.48~2.16)。PSM结果相似(AHR 4.52，95%CI 2.43~8.42)。马尔尼菲毛滴虫感染患者的死亡率也显著高于无任何并发症的患者。当按人口学特征分层时，马尔尼菲毛滴虫感染在所有分层中都有较高的死亡风险。结论：马尔尼菲毛霉菌感染是中国南部地区艾滋病住院患者中常见的一种感染方式，其病死率高于大多数HIV相关并发症。这些结果突显了在中国南部改进这种被忽视的真菌病原体感染的诊断、治疗和预防的必要性。(C)2018年欧洲临床微生物学和传染病学会。爱思唯尔有限公司出版。保留所有权利。
Objective: Talaromyces marneffei is an opportunistic infection with high morbidity among human immunodeficiency virus (HIV)/AIDS patients in Southeast Asia and southern China. Its effects on mortality in HIV/AIDS patients has not been clearly elucidated.Methods: We conducted a retrospective cohort study of hospitalized HIV-infected individuals at the Fourth People's Hospital of Nanning, Guangxi, China during 2012-2015. Kaplan-Meier analyses were used to calculate the cumulative mortality. Cox proportional hazard models and 1:1 propensity score matching (PSM) were used to evaluate the effects of T. marneffei infection on mortality of HIV/AIDS patients.Results: In total, 6791 HIV/AIDS patients were included, 1093 of them (16.1%) with documented T. marneffei co-infection. The mortality of T. marneffei-infected patients (25.0 per 100 person-months, 95% CI 21.5-26.7) was the highest among all AIDS-associated complications and was significantly higher than that of T. marneffei-uninfected HIV/AIDS patients (13.8 per 100 person-months, 95% CI 12.5-15.1; adjusted hazard ratio (AHR) 1.80, 95% CI 1.48-2.16). The results using PSM were similar (AHR 4.52 95% CI 2.43-8.42). The mortality of T. marneffei-infected patients was also significantly higher than that of patients without any complications. When stratified by demographic characteristics, T. marneffei infection has higher mortality risk in all stratifications. Co-infection with T. marneffei carries a higher mortality risk in patients at any CD4(+) T-cell count.Conclusions: Talaromyces marneffei infection is commonly found in hospitalized HIV/AIDS patients in southern China and was associated with a higher mortality rate than most HIV-associated complications. These results highlight the need for improved diagnosis, treatment and prevention of infection by this neglected fungal pathogen in southern China. (C) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.