Prognostic Efficacy Of Amphotericin B And Itraconazole As Initial Treatment For AIDS Patients With Talaromycosis: A Meta-analysis

Background:Talaromyces marneffei(TM)is a thermal dimorphic fungus that causes systemic fungal disease in humans.It is prevalent in immunocompromised populations,which is one of the leading causes of death in patients with AIDS in Southeast and South Asia.There are no standard choices on antifungal drugs for the induction treatment of AIDS patients infected with talaromycosis due to various factors.Objective:In this study,we summarized and analyzed the prognostic effects of amphotericin B(Am B)and itraconazole(ITZ)induction therapy in patients with AIDS infected with TM in a meta-analysis to provide more references for clinical drug selection.Methods:Literature published about the effect of induction therapy with amphotericin B or itraconazole on mortality of patients with AIDS infected with TM were searched from Pub Med,Web of Science,Google,Cochrane Library,CNKI,Vipshop,and Wanfang databases from inception to February 1,2021.The Jadad scale and the Newcastle Ottawa scale(NOS)were used for risk assessment of the included studies.Risk of death was assessed by combining Relative risk(RR)and 95%confidence interval(CI).And data were extracted using Rev Man 5.4 software for meta-analysis.Result:Of the 612 relevant literature records,10 studies met the inclusion criteria,including 1 randomized controlled study,1 case-control study and 8 cohort studies,with a combined study case load of 1647 cases,including 1088 cases in the Am B group with 145 deaths(13.32%)and 559 cases in the ITZ group with 93 deaths(16.64%).Induction therapy with Am B significantly reduced mortality in patients with AIDS infected with TM compared with ITZ(RR 0.70;95%CI[0.53,0.91];P=0.009;I~2=25%).According to different modes of administration of ITZ initial therapy(intravenous or oral)to make subgroup analysis,it is found that Am B significantly reduced mortality of patients with AIDS infected with TM in the oral administration group compared to ITZ(RR 0.56;95%CI[0.38,0.83];P=0.004;I~2=0%),while the intravenous administration group showed no significant prognostic advantage(RR 0.65;95%CI[0.32,1.32];P=0.23;I~2=55%).Conclusion:Compared to ITZ,the use of Am B induction therapy for patients with AIDS infected with TM has a better prognosis and lower mortality.