We evaluated Talaromyces marneffei mannoprotein (Mp1p) antigen in urine to create a practical, rapid diagnostic tool for early treatment and reduced mortality.

This prospective cross-sectional study assessed the sensitivity and specificity of Mp1p detection in urine samples from 215 AIDS patients at Guangzhou Eighth People's Hospital, enrolled between March 2022 and January 2023, using ELISA and fluorescence immunochromatography (FIC). In both the Talaromycosis and non-talaromycosis groups, most patients were male, comprising 82.5 % and 88.6 %, respectively. The median age was 42 years for the talaromycosis group and 48 years for the non-talaromycosis group. All patients were HIV-infected, with median CD4+ T cell counts of 47 cells/μL for talaromycosis and 187 cells/μL for non-talaromycosis. Among detection methods, ELISA showed the highest sensitivity (77.5 %, 95 % CI: 61.5–89.2 %) and specificity (97.1 %, 95 % CI: 93.5–99.1 %) for the Mp1p antigen in urine. The Positive Predictive Value (PPV), Negative Predictive Value (NPV), and kappa coefficient were 79.5 % (31/39), 94.9 % (167/176), and 0.739, respectively. The Area Under the Curve (AUC) accuracy for distinguishing patients with talaromycosis was 85.8 % (95 % CI, 76.9–94.9 %). The sensitivity, specificity, PPV, NPV, and kappa value of the Mp1p antigen (Ag) in urine following FIC were 67.5 % (95 % CI: 50.9–81.4 %), 94.9 % (95 % CI: 90.5–97.6 %), 75 % (27/36), 92.7 % (166/179), and 0.649, respectively. Combining urine Mp1p Ag ELISA with serum Mp1p Ag FIC achieved the highest specificity (96 %), PPV (82.1 %), and kappa value (0.767). In contrast, the urine Mp1p Ag ELISA and serum GM Ag pairing showed the highest sensitivity (92.5 %) and NPV (98.1 %).

Identification of the Mp1p antigen (Ag) in urine has been shown to be a reliable method for differentiating coinfections in AIDS patients, serving as a supplementary tool for early detection in clinical settings.