Is stopping secondary prophylaxis safe in HIV-positive talaromycosis patients? Experience from Myanmar

Prevalence of bone destruction in patients with TALAROMYCES MARNEFFEI infection: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate the prevalence of bone destruction in patients with Talaromyces marneffei infection, examine distribution patterns of bone lesions, and assess differences between HIV-positive and HIV-negative patients.

METHODS

Following PRISMA guidelines, 15 studies involving 839 patients were analyzed. Random-effects meta-analysis was performed to estimate prevalence and odds ratios. Study quality was assessed using ROBINS-I.

RESULTS

The overall prevalence of bone destruction was 18% (95% CI: 10-27%). HIV-negative patients showed significantly higher odds of bone destruction (OR: 0.09, 95% CI: 0.02-0.37%). Bone lesions were widely distributed, with osseous involvement (45.7-71.4%) more prevalent than articular (7.1-66.7%). The skull, ribs, and lumbar vertebrae were commonly affected.

CONCLUSION

Bone destruction is a significant complication in TM infection, particularly in HIV-negative patients. The diverse anatomical distribution emphasizes the need for comprehensive skeletal assessment in suspected cases.

Acquired Immunodeficiency Syndrome Professional Group, Society of Infectious Diseases, Chinese Medical Association; Chinese Center for Disease Control and Prevention. Chinese guidelines for the diagnosis and treatment of human immunodeficiency virus infection/acquired immunodeficiency syndrome (2024 edition)

ABSTRACT

The Acquired Immunodeficiency Syndrome Professional Group of the Society of Infectious Diseases of the Chinese Medical Association formulated the first edition of the Chinese Guidelines for the Diagnosis and Treatment of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (referred to as the Guidelines) in 2005. The 2024 edition of the Guidelines has been compiled by updating the 2021 fifth edition, incorporating the latest research advancements in antiviral therapy, comprehensive management, opportunistic infections, concurrent tumors, and the prevention and intervention of HIV infection. The new edition also introduces a new section on "Incomplete immune reconstitution", proposes the concept of "HIV vulnerable populations" for the first time with recommendations for their diagnosis and treatment. This edition of the Guidelines covers 14 sections: epidemiology, pathogenic characteristics, laboratory tests, pathogenesis, clinical presentation and staging, diagnostic criteria, common opportunistic infections, antiretroviral therapy, immune reconstitution inflammatory syndrome, incomplete immune reconstitution, AIDS-related neoplasms, prevention of mother-to-child transmission and conception in serodiscordant couples, pre- and post-exposure prophylaxis, and whole-course management of HIV infection. This edition of the Guidelines aims to assist clinical physicians in making informed decisions in the diagnosis, treatment, and management of HIV/AIDS and will be periodically revised and updated based on domestic and international research progress.

An Overview of Diagnostic and Management Strategies for Talaromycosis, an Underrated Disease

Underrated and neglected, talaromycosis is a life-threatening fungal disease endemic to the tropical and subtropical regions of Asia. In China, it has been reported that talaromycosis mortality doubles from 24 to 50% when the diagnosis is delayed, and reaches 100% when the diagnosis is missed. Thus, the accurate diagnosis of talaromycosis is of utmost importance. Herein, in the first part of this article, we provide an extensive review of the diagnostic tools used thus far by physicians in the management of cases of talaromycosis. The challenges encountered and the perspectives which may aid in the discovery of more accurate and reliable diagnostic approaches are also discussed. In the second part of this review, we discuss the drugs used to prevent and treat T. marneffei infection. Alternative therapeutic options and potential drug resistance reported in the contemporary literature are also discussed. We aim to guide researchers towards the discovery of novel approaches to prevent, diagnose, and treat talaromycosis, and therefore improve the prognosis for those afflicted by this important disease.