Effects of Talaromyces marneffei infection on mortality of HIV/AIDS patients in southern China: a retrospective cohort study

马尔尼菲青霉菌 医学 回顾性队列研究 机会性感染 危险系数 队列 内科学 死亡率 队列研究 西达 倾向得分匹配 比例危险模型 人类免疫缺陷病毒(HIV) 免疫学 病毒性疾病 共感染 置信区间
作者
Jiyi Jiang,Sirun Meng,Sean Shenghsiu Huang,Yuhua Ruan,Xiaoping Lü,J.Z. Li,Nianning Wu,Jian Huang,Zhenye Xie,Bing Liang,Jingyu Deng,Bo Zhou,Xiaoyuan Chen,Chuanyi Ning,Yulin Liao,Wenxin Wei,Jingzhen Lai,Li Ye,Fengyao Wu,Hao Liang
出处
期刊:Clinical Microbiology and Infection [Elsevier]
卷期号:25 (2): 233-241 被引量:117
标识
DOI:10.1016/j.cmi.2018.04.018
摘要

ObjectiveTalaromyces 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.MethodsWe 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.ResultsIn 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.ConclusionsTalaromyces 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.
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