Hematological toxicity of amphotericin B deoxycholate-based induction therapy in patients with HIV-associated talaromycosis
BACKGROUND: This study''s objective was to investigate the predictors for severe anemia, severe leukopenia, and severe thrombocytopenia when amphotericin B deoxycholate-based induction therapy is used in HIV patients with talaromycosis.
METHODS: This was a prospective, multi-center, observational study. A total of 170 HIV patients with talaromycosis were enrolled at 11 hospitals located in 9 cities from January 1st, 2019 to September 30th, 2020. Patients received treatment for 14 days with amphotericin B deoxycholate at a dose of 0.5 to 0.7 mg per kilogram per day. Multivariate logistic regression was used to analyze.
RESULTS: Among these 170 patients, 24 (14.1%) were female. Approximately 42.9%, 20.6%, and 10.6% of the enrolled patients developed severe anemia, severe leukopenia, and severe thrombocytopenia, respectively. Baseline lower hemoglobin levels (OR=0.938, 95% CI: 0.913~0.965), higher serum creatinine levels (OR=1.023, 95% CI: 1.003~1.044), higher AST/ALT ratios (OR=1.543, 95% CI: 1.170~2.036), lower sodium levels (OR=0.922, 95% CI: 0.855~0.995), and a dose of amphotericin B deoxycholate >0.58 mg/kg/d (OR=2.504, 95% CI:1.066~5.882) were independent risk factors associated with the development of severe anemia. Co-infection with tuberculosis (OR=3.313, 95% CI:1.052~10.439), and lower platelet levels (OR=0.995, 95% CI: 0.990~0.999) at baseline was shown to be independent risk factors associated with the development of severe leukopenia. A lower platelet level (OR=0.991, 95% CI: 0.984~0.998) at baseline was the independent risk factor found to be associated with the development of severe thrombocytopenia.
CONCLUSIONS: The preceding findings reveal risk factors for severe anemia, severe leukopenia, and severe thrombocytopenia, which will favor prevention and timely treatment of hematological toxicity, improvement of patient outcomes, shorter hospital stays, and a reduction of the requirement for blood transfusion.
Y. Zhou (1,2), T. Lu (2), Y. Li (2), Y. Qin (1), Y. Lu (1), Q. Tian (3), K. Lan (4), G. Zhou (5), Y. Qin (6), V. Harypursat (1), S. Lin (2), Y. Chen * (1,2)
(1) Chongqing Public Health Medical Center, Chongqing, China, (2) Zunyi Medical University, Zunyi, China, (3) the Third People''s Hospital of Guilin, Guilin, China, (4) Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China, (5) the First Hospital of Changsha, Changsha, China, (6) the Fourth Peopleâ??s Hospital of Nanning, Nanning, China