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Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort
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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023982/ https://www.ncbi.nlm.nih.gov/pubmed/33644813 http://dx.doi.org/10.1093/mmy/myab005 |
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author | Klus, Jonathan Ly, Vo Trieu Chan, Cliburn Le, Thuy |
author_facet | Klus, Jonathan Ly, Vo Trieu Chan, Cliburn Le, Thuy |
author_sort | Klus, Jonathan |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8023982 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-80239822021-04-13 Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort Klus, Jonathan Ly, Vo Trieu Chan, Cliburn Le, Thuy Med Mycol Original Article 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. Oxford University Press 2021-02-27 /pmc/articles/PMC8023982/ /pubmed/33644813 http://dx.doi.org/10.1093/mmy/myab005 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Klus, Jonathan Ly, Vo Trieu Chan, Cliburn Le, Thuy Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort |
title | Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort |
title_full | Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort |
title_fullStr | Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort |
title_full_unstemmed | Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort |
title_short | Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort |
title_sort | prognosis and treatment effects of hiv-associated talaromycosis in a real-world patient cohort |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023982/ https://www.ncbi.nlm.nih.gov/pubmed/33644813 http://dx.doi.org/10.1093/mmy/myab005 |
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