Clinical features of talaromycosis in people living with HIV/AIDS (PWHA) and patients with anti-interferon-γ autoantibodies

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BACKGROUND: Talaromycosis is increasingly reported in HIV-uninfected, immunocompromised individuals in an endemic area. The aim of this study was to compare the characteristics and mortality associated with talaromycosis in adult immunocompromised individuals caused by the anti-interferon-gamma autoantibody (anti-IFN- γ AAb) with those of people living with HIV/AIDS (PWHA). METHODS: A retrospective cohort study was conducted at Maharaj Nakorn Chiang Mai Hospital, Thailand, in adults with confirmed HIV infection or anti-IFN- γ-AAbs diagnosed with talaromycosis. RESULTS: Thirty-two patients with anti-IFN- γ-AAbs and 235 PWHA were included. Patients with anti-IFN- γ-AAbs were older and more likely to have comorbidities. PWHA were more likely to have constitutional symptoms, cough, dyspnea, diarrhea, splenomegaly, umbilicated skin lesions, abnormal chest radiographs, and fungemia. Patients with anti-IFN- γ-AAbs were more likely to have skin lesions such as macule/papules/nodules, abscesses and Sweet's syndrome, as well as bone and joint infections and higher white blood cell counts. The time from first symptom to treatment was longer in patients with anti-IFN- γ-AAbs (44.5 days vs. 30.0 days, p-value = 0.049). The 24-week mortality rate was 9.4% (3 patients) in patients with anti-IFN- γ-AAbs and 15.3% (36 patients) in PWHA (p-value = 0.372). CONCLUSIONS: The clinical features of talaromycosis in patients with anti-IFN- γ-AAbs differed from PWHA. Clinicians in areas where talaromycosis is endemic should be aware of the different features of talaromycosis in patients with anti-IFN- γ AAbs.

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