Galactomannan Antigenemia among People Living with HIV: An Observational Study in Taiwan, 2009-2019

Abstract

Objectives: The clinical impact of elevated serum galactomannan (GM) in HIV treatment-naïve patients is unclear. We evaluated the prevalence and significance of GM antigenemia in people with HIV (PLHIV) in a talaromycosis-endemic area. Methods: From January 2009 to August 2019, we tested GM levels within a week of HIV diagnosis and reviewed initial medical records. Using a 1:1 case-control method, we matched GM-positive patients with controls to explore risk factors. We monitored GM levels in 81 patients to assess seroconversion. Results: Among 929 HIV/AIDS patients, 72 (7.8%) had positive GM tests with a median CD4 count of 324 cells/μL. None developed aspergillosis or talaromycosis after three months, and no deaths occurred during a one-year follow-up. Positive HAV (p = 0.011) and HCV (p = 0.012) serology were significantly associated with antigenemia. Patients with CD4 counts < 50 cells/μL had higher GM levels. Of 81 patients monitored, only one remained GM-positive after 1701 days. None of the initially negative patients seroconverted. Conclusions: GM antigenemia is common in PLHIV in Taiwan, but did not lead to disease after antiretroviral therapy. Continuous monitoring is preferable to immediate antifungal treatment.

Keywords

galactomannan antigen test / human immunodeficiency virus / acquired immunodeficiency syndrome / talaromycosis

Author Contributions

Y.-T.H. and C.-J.Y.: concept and design of the study; M.-S.T., C.-H.L., and C.-Y.S.: acquisition of clinical data; Y.-T.H. and Y.-W.K.: data analysis and data interpretation; Y.-T.H., Y.-W.K., M.-S.T., C.-H.L., C.-Y.S. and C.-J.Y.: revising the manuscript critically for important intellectual content; Y.-T.H. and C.-J.Y.: drafting and revision of the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by the grant of Far Eastern Memorial Hospital (FEMH-2019-C-014).

Institutional Review Board Statement

This study was approved by the Research Ethics Committee of FEMH (107118-F and 109173-F); informed consent from each patient was not required for the routine test; and case-control study was approved (IRB number 107118-F). For the follow-up GM testing study, informed consent was required (IRB number 109173-F).

Conflicts of Interest

C.-J.Y. received speaker honoraria from Gilead Sciences, Merck, Pfizer and GSK/ViiV. M.-S.T. has received speaker honoraria from Gilead Sciences. C.-H.L. has received speaker honoraria from Pfizer. The other authors have no conflicts of interest.

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