Long-term treatment outcomes among AIDS patients with and without talaromycosis: A retrospective study

To compare the long-term outcomes among AIDS patients with and without talaromycosis following initiation of antiretroviral therapy (ART).

This retrospective study included ART-naïve AIDS patients hospitalized at Guangzhou Eighth People's Hospital between January 1 and December 31, 2018. During the study period, ART was initiated in all patients per the standard of care. Virological outcomes, immunological responses, and mortality rates were assessed over the following five years.

A total of 299 patients were included and 96 (32.1 %) were infected with Talaromyces marneffei. At baseline, patients with talaromycosis had a significantly lower CD4⁺ count (12.0 cells/μL vs. 41.0 cells/μL) and CD4⁺/CD8⁺ ratio (0.06 vs. 0.10) (all P < 0.01). By 60 months, the CD4⁺ count had significantly increased to 370.0 cells/μL in the talaromycosis group and to 427.5 cells/μL in the non-talaromycosis group. The CD4⁺/CD8⁺ ratio improved to 0.53 and 0.56. The incidence of immune non-responders (INRs) during 24-60 months of follow-up in the two groups were 66.7 % vs. 55.4 %, 58.0 % vs. 50.6 %, 56.9 % vs. 47.6 %, 46.8 % vs. 40.5 %, 43.8 % vs. 32.9 %, 42.6 % vs. 29.2 %, 39.1 % vs. 31.1 %, respectively. Generally, differences in immune reconstitution were evident during the first 24 months but became non-significant between 30 and 60 months. The rates of viral suppression in the non-talaromycosis and talaromycosis groups during the five-year follow-up were 77.0 % vs. 71.0 %, 92.9 % vs. 91.2 %, 92.7 % vs. 86.3 %, 94.9 % vs. 90.0 %, 90.8 % vs. 93.6 %, respectively, and were comparable between the two groups (P = 0.18, 0.96, 0.37, 0.47, and 0.83). Similarly, the cumulative mortality did not differ significantly (11.3 % vs. 15.0 %, P = 0.345).

ART has a sustained impact on immune reconstitution, and the long-term outcomes of AIDS patients with talaromycosis are not inferior to those without talaromycosis. Therefore, timely ART is critical for improving prognosis of AIDS patients with talaromycosis.