Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort.

Klus, Jonathan

Ly, Vo Trieu

Chan, Cliburn

Le, Thuy

2021-08-18T18:11:58Z

2021-08-18T18:11:58Z

2021-04

2021-08-18T18:11:57Z

Talaromycosis is a leading cause of AIDS-associated opportunistic infections and death in Southeast Asia. We have recently shown in the Itraconazole versus Amphotericin for Talaromycosis (IVAP) trial that induction therapy with amphotericin B reduced mortality over 24 weeks, but not during the first 2 weeks. Antifungal treatment effects in real-world settings have not been rigorously evaluated. Using data obtained from patient records at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam from 2004 to 2009, we first developed a prognostic model using Bayesian logistic regression to identify predictors of death. Second, we developed a causal model using propensity score matching to assess the treatment effects of amphotericin B and itraconazole. Our prognostic model identified intravenous drug use (odds ratio [OR] = 2.01), higher respiratory rate (OR = 1.12), higher absolute lymphocyte count (OR = 1.62), a concurrent respiratory infection (OR = 1.67) or central nervous system infection (OR = 2.66) as independent predictors of death. Fever (OR = 0.56) was a protective factor. Our prognostic model exhibits good in-sample performance and out-of-sample validation, with a discrimination power of 0.85 and 0.91, respectively. Our causal model showed no significant difference in treatment outcomes between amphotericin B and itraconazole over the first 2 weeks (95% credible interval: 0.62, 2.50). Our prognostic model provides a simple tool based on routinely collected clinical data to predict individual patient outcome. Our causal model shows similar results to the IVAP trial at 2 weeks, demonstrating an agreement between real-world data and clinical trial data.

6153731

1369-3786

1460-2709

https://hdl.handle.net/10161/23599

eng

Oxford University Press (OUP)

Medical mycology

10.1093/mmy/myab005

Talaromyces marneffei

HIV

penicilliosis

prognosis

talaromycosis

Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort.

Journal article

Chan, Cliburn|0000-0001-5901-6806

Le, Thuy|0000-0002-3393-6580

392

399

4

School of Medicine

Molecular Genetics and Microbiology

Duke Global Health Institute

Medicine, Infectious Diseases

Duke

Basic Science Departments

University Institutes and Centers

Institutes and Provost's Academic Units

Medicine

Clinical Science Departments

Statistical Science

Biostatistics & Bioinformatics

Trinity College of Arts & Sciences

Published

59