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

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.