Albuvirtide-based regimens for advanced- stage HIV and Talaromyces marneffei co-infection: A longitudinal case series

ObjectiveTalaromyces marneffei (TM) represents a major opportunistic infection among People living with HIV (PLWH) in Southeast Asia and southern China. This study aimed to evaluate the efficacy and safety of Albuvirtide (ABT, currently licensed only in China)-based antiretroviral regimens during the advanced stage of infection in this understudied population.MethodsWe conducted a longitudinal case series from June 2022 to March 2024 at two hospitals in Guangxi, China. The study included treatment-naive HIV/TM co-infected patients who initiated ABT-based antiretroviral therapy combined with oral background regimens (predominantly dolutegravir/lamivudine or bictegravir/emtricitabine/tenofovir alafenamide). Analyses and findings evaluated after 6 weeks of treatment included changes in HIV viral load, CD4 + T-cell count, and CD4/CD8 ratio. Data were analyzed using Wilcoxon signed-rank and McNemar's tests.ResultsA total of 52 patients were included. Excluding one patient lost to follow-up, the 6-week survival rate was 98.0% (50/51), with a single mortality attributed to advanced disease. In the 50 patients analyzed, the median viral load decreased rapidly from 274,500 (IQR: 52,775-794,874) to 119.5 (IQR: 40-464.5) copies/mL (P < 0.001). The median CD4 + T-cell count increased significantly from 14.0 (IQR: 5.0-32.0) to 83.5 (IQR: 35.0-127.75) cells/μL (P < 0.001). The CD4/CD8 ratio showed an improving trend (0.065 to 0.100, P = 0.058). No severe adverse events related to the study drugs were observed.ConclusionFindings from this small case series suggest that ABT-based regimens demonstrated a favorable safety profile and achieved rapid viral suppression during the critical advanced stage of HIV/TM co-infection. These findings suggest that adding parenteral ABT to oral background regimens provides a feasible and intensified treatment strategy to stabilize critically ill patients, particularly those with potential gastrointestinal dysfunction.