Updates to the Talaromycosis Section of the Adult and Adolescent Opportunistic Infections Guidelines
November 12, 2019: The Talaromycosis (formerly Penicilliosis) section of the Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV has been updated. The Panel updated the text, epidemiology, diagnosis, treatment, and references throughout the section and made the following key changes:
Primary prophylaxis is only recommended for patients with HIV with CD4 counts <100 cells/mm3 who reside in the highly endemic regions in northern Thailand, southern China, and northern and southern Vietnam who are unable to take antiretroviral therapy (ART) for whatever reason or have treatment failure without access to effective antiretroviral options (BI). The drug choices for prophylaxis are oral itraconazole 200 mg once daily (BI) or oral fluconazole 400 mg once weekly (BII). Primary prophylaxis is not recommended for patients who are on or about to start effective ART, and it is not recommended in geographic areas outside of the mentioned highly endemic regions (AIII).
The recommended induction therapy for all patients, regardless of disease severity, is amphotericin B, preferably liposomal amphotericin B 3 to 5 mg/kg body weight/day where available, or deoxycholate amphotericin B 0.7 mg/kg body weight/day, intravenously for 2 weeks (AI).
Induction therapy should be followed by consolidation therapy with oral itraconazole, 200 mg every 12 hours for a subsequent duration of 10 weeks (AI). After this period, maintenance therapy (or secondary prophylaxis) with oral itraconazole 200 mg/day is recommended to prevent recurrence until the CD4 count rises above 100 cells/mm3 for at least 6 months (AII).