Penicilliosis marneffei (PM) is endemic disease in many areas in Southeast Asia, South China, Hong Kong, Taiwan, and India. This disease is also the fourth most common opportunistic infection in human immunodeficiency virus (HIV) -infected patients in northern Thailand, after tuberculosis, pneumocystis carinii pneumonia and cryptococcal meningitis. However, the optimal time to start antiretroviral therapy (ART) in HIV-infected patients with PM is still not clear.
This Retrospective cohort study was done by reviewing the medical records of HIV-infected patients with PM at Chiang Mai University Hospital from January 1, 2001 to October 31, 2015. Patients were allocated to early ART (< 30 days of starting PM treatment) or delayed ART (> 30 days of starting PM treatment) and followed until 48 weeks after starting ART. Demographic and clinical data were recorded. The primary endpoints were mortality or hospitalization rate at 24 weeks after starting ART. Prevalence of new AIDS-defining illness, relapse of PM, immune reconstitution inflammatory syndrome (IRIS) or virological failure at 24 and 48 weeks after starting ART were recorded.
A total of 81 patients were enrolled to the study (20 patients in the early ART group and 61 patients in the delayed ART group). The median of absolute CD4 cell count at enrollment in the early vs delayed ART group were 17.00 and 25.50 cells/mm3, respectively (p = 0.07). There were no reports of deaths in both groups. The hospitalization rates were not statistically different between the early and delayed ART groups at 24 (10.00% vs 8.20%; p = 0.56). The prevalence of opportunistic infections (such as CMV infection, etc.) differed between the early and delayed ART groups at 24 weeks after ART, but it was not statistically significant (0.00% vs 13.11%; p = 0.09). There were no statistical difference of the prevalence of other opportunistic infections, relapse of PM, IRIS and virological failure at 24 and 48 weeks after ART between both groups.
Conclusion: There were no differences in mortality, hospitalization rate, relapse of PM, IRIS and virological failure between early and delayed ART groups. Although there was a trend for higher rate of other opportunistic infections in the delayed ART group; this was not statistically significant. Further prospective study is needed.
K. Supparatpinyo, None