Effects of cotrimoxazole prophylaxis on Talaromyces marneffei infection in HIV/ AIDS patients receiving antiretroviral therapy: a retrospective cohort study

• Type of Material: Article
• Authors: Junjun Jiang, Guangxi Medical University; Fengxiang Qin, Guangxi Medical University; Sirun Meng, Fourth Peoples Hosp Nanning; Eric Nehl, Emory University; Jinping Huang, Fourth Peoples Hosp Nanning; Yanfen Liu, Fourth Peoples Hosp Nanning; Jun Zou, Fourth Peoples Hosp Nanning; Wenyi Dong, Fourth Peoples Hosp Nanning; Jiegang Huang, Guangxi Medical University; Hui Chen, Guangxi Medical University; Ning Zang, Guangxi Medical University; Bingyu Liang, Guangxi Medical University; Chuanyi Ning, Guangxi Medical University; Yanyan Liao, Guangxi Medical University; Chaolian Luo, Guangxi Medical University; Huifang Liu, Guangxi Medical University; Xin Liu, Guangxi Medical University; Jian Wang, Emory University; Oulu Zhou, Guangxi Medical University; Le Thuy, Duke University; Li Ye, Guangxi Medical University; Fengyao Wu, Fourth Peoples Hosp Nanning; Hao Liang, Guangxi Medical University
• Language: English
• Date: 2019-03-11
• Publisher: TAYLOR & FRANCIS LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Shanghai Shangyixun Cultural Communication Co., Ltd
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/22221751.2019.1588078
• Title of Journal or Parent Work: Emerging Microbes and Infections
• Volume: 8
• Issue: 1
• Start Page: 367
• End Page: 376
• Grant/Funding Information: The study was supported by National Natural Science Foundation of China [NSFC, grant number 81560326, 81460511, 81703275, 31860040], Guangxi Scientific and Technological Key Project [Gui Ke Gong grant number 14124003-1], Guangxi Science Fund for Distinguished Young Scholars [grant number 2018GXNSFFA281001], China Postdoctoral Science Foundation [grant number 2018M640890], Guangxi Bagui Young Scholar (to Junjun Jiang), Thousands of Young and Middle-aged Key Teachers Training Program in Guangxi Colleges and Universities (to Junjun Jiang).
• Keywords: AIDS; HIV; antiretroviral therapy; TUBERCULOSIS; Microbiology; PREDICTORS; Life Sciences & Biomedicine; OBSERVATIONAL COHORT; RISK-FACTORS; Science & Technology; Immunology; CHI MINH CITY; ADULTS; PNEUMONIA; cotrimoxazole; Talaromyces marneffei; EPIDEMIOLOGY
• Research Categories: Biology, Microbiology; Health Sciences, Public Health; Health Sciences, Pharmacology

Abstract

The dimorphic fungus Talaromyces marneffei (TM) is a common cause of HIV-associated opportunistic infections in Southeast Asia. Cotrimoxazole (CTX) inhibits folic 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 (<50 cells/μL, 50–99 cells/μL, 100–199 cells/μL), with the highest reduction observed in patients with a baseline CD4 + cell count <50 cells/μL in both Cox regression and the PSM analyses. In conclusion, in addition to preventing other HIV-associated opportunistic infections, CTX prophylaxis has the potential to prevent TM infection in HIV/AIDS patients receiving ART.