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Talaromyces marneffei (formerly Penicillium marneffei) is a dimorphic fungus endemic to Southeast Asia that causes a fatal disseminated mycosis in immunosuppressed individuals and is a common HIV-associated pathogen in that region. Standard treatment consists of a 2-week induction with amphotericin B followed by long-term suppression with itraconazole. However, amphotericin's expense and toxicity have raised hopes that patients might do well with itraconazole alone.
In a nonblinded trial, 440 HIV-infected adults with newly diagnosed talaromycosis were randomized to receive either standard doses of amphotericin B deoxycholate for 2 weeks or high-dose oral itraconazole (300 mg twice daily for two days, then 200 mg twice daily for 11 days). All…