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Abstract：
High titers of anti-interferon-γ autoantibodies (AIGAs) are an important factor leading to persistent, relapsed, and refractory infections in HIV-negative hosts infected with Talaromyces marneffei (TM). We report 5 patients treated with pulses of high-dose intravenous cyclophosphamide (IVCY) who were followed for 2 years. Before IVCY therapy, all patients had multiple relapses, with a median (interquartile range [IQR]) of 2 (1-3) instances of relapse. The median serum AIGA titers (IQR) were 58 753 (41 203-89 605) ng/mL at diagnosis, 48 189.4 (15 537-83 375) ng/mL before IVCY therapy, and 10 721.2 (5637-13 245) ng/mL at the end of IVCY therapy (P < .05). After 3 months of follow-up, the median AIGA titers (IQR) rose gradually to 21 232.6 (9896-45 626) ng/mL, and to 37 464.2 (19 872-58 321) ng/mL at 24 months (P < .05). Five patients discontinued antimicrobial therapy within 3-12 months after completion of IVCY therapy, but only 1 patient had a relapse. In conclusion, pulses of short-term and high-dose IVCY can effectively reduce AIGA titers.
摘要：
高滴度的抗-干扰素-γ自身抗体(AIGA)是导致持续,复发,和感染马尔尼菲Talaromyces（TM）的HIV阴性宿主的难治性感染。我们报告了5例接受大剂量静脉内环磷酰胺（IVCY）脉冲治疗的患者，随访2年。IVCY治疗前,所有患者都有多次复发，中位数（四分位数范围[IQR]）为2（1-3）例复发。诊断时血清AIGA滴度中位数（IQR）为58753（41203-89605）ng/mL，IVCY治疗前48189.4（15537-83375）ng/mL，IVCY治疗结束时10721.2（5637-13245）ng/mL（P<0.05）。经过3个月的随访，AIGA滴度中位数（IQR）逐渐上升至21232.6（9896-45626）ng/mL，在24个月时达到37464.2（19872-58321）ng/mL（P<0.05）。5例患者在IVCY治疗结束后3-12个月内停止抗菌治疗，但只有1例患者复发。总之,短期和高剂量IVCY脉冲可有效降低AIGA滴度。
