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。