Penicilliosis and AIDS in Haiphong, Vietnam: evolution and predictive factors of death.
OBJECTIVE
The study objective was to assess the lethality rates and the predictive factors for death in AIDS patients infected by Penicillium marneffei (Pm) in Hai Phong, Vietnam.


METHODS
A retrospective cohort study was conducted by reviewing 103 medicals records of confirmed cases from June 2006 to August 2009.


RESULTS
Penicilliosis-related mortality was very high (33%). The majors risk factors of death were: (i) patient lacking complete treatment, a regimen with both of secondary prophylaxis by itraconazole and HAART (OR=52.2, P<0.001); (ii) patients having received only secondary prophylaxis (OR=21.2, P<0.001); (iii) patients coinfected by hepatitis C (OR=2.3, P=0.02) and tuberculosis (OR=1.97, P=0.04). Penicilliosis occurred in 28 cases after initiation of ART, probably caused by IRIS, with the same signs and symptoms as "common" penicilliosis. However, the diagnosis of IRIS was ruled out because the viral load could not be assessed.


CONCLUSIONS
Penicilliosis is very frequent in the North of Vietnam. A good compliance to a complete treatment with healing antifungal (Amphotericin B) then secondary prophylaxis (Itraconazole) associate with ART, prolongs survival, prevents relapse, and also allows discontinuing a secondary prophylaxis in a half of the cases.
Institut francophone pour la médecine tropicale, rue Samsènethai, BP 9519, Vientiane, Lao Democratic People's Republic.
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Son
Université de médecine et de pharmacie de Haiphong, 72A, Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Viet Nam. Electronic address: pmkhue@hpmu.edu.vn.
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Khue
Institut francophone pour la médecine tropicale, rue Samsènethai, BP 9519, Vientiane, Lao Democratic People's Republic.
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Strobel
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D017964:Itraconazole / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D010407:Penicillium / Q000302:isolation & purification*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology; D014744:Vietnam / Q000453:epidemiology
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B
Facteurs de risque de mortalité; HIV/AIDS; Penicilliosis; Predictive factor of death; Pénicilliose; VIH/Sida