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Predictors of poor outcome of penicilliosis in AIDS (now Talaromyces marneffei infection) in Vietnam

January 09 2015

Predictors of poor outcome of penicilliosis in AIDS (now Talaromyces marneffei infection) in Vietnam

Untreated T. marneffei infection in AIDS is fatal. In this series from Hai Phong in northern Vietnam found that both a lack of secondary prophylaxis and anti-retroviral therapy were highly correlated with worse outcome (OR 52.2), and conversely almost all the patients treated with both ARVs and secondary prophylaxis with itraconazole 200mg daily survived for over 3 years. Co-infection with hepatitis C or TB conferred a slightly worse outcome (OR =2.3 and 1.97 respectively).

A new observation was that 25% of the patients presented after starting ARVs, usually within 2 months. These patients had a similar clinical presentation to those with T. marneffei infection diagnosed pre-ARV therapy.

T. marneffei infection accounts for 10% of opportunistic infection in AIDS, after TB, ‘disseminated candidiasis’ and Pneumocystis pneumonia, and is much more common in this locality than cryptococcal meningitis. In Vietnam, intravenous drug addiction is the most common risk factor for HIV infection and patients usually present very late with CD4 counts under 50 x 106/L.

Articles: Hai et al 2010; Son et al 2014   More information on Talaromyces marneffei infection and T. marneffei (formerly penicilliosis).