High Mortality of Disseminated Non-Tuberculous Mycobacterial Infection in HIV-Infected Patients in the Antiretroviral Therapy Era
BACKGROUND:
Little
information is available on the mortality and risk factors associated with
death in disseminated non-tuberculous mycobacterial infection (dNTM) in HIV-infected
patients in the ART-era.
METHODS:
In a
single-center study, HIV-infected dNTM with positive NTM culture from sterile
sites between 2000 and 2013 were analysed. The clinical characteristics at
commencement of anti-mycobacterial treatment (baseline) were compared between
those who survived and died.
RESULTS:
Twenty-four
patients were analyzed. [The median CD4 27/μL (range 2-185)]. Mycobacterium
avium and M. intracellulare accounted for 20 (83%) and 3 (13%) of isolated NTM.
NTM bacteremia was diagnosed in 15 (63%) patients. Seven (29%) patients died,
and NTM bacteremia was significantly associated with mortality (p = 0.022). The
baseline CD4 count was significantly lower in the non-survivors than the
survivors (median 7/μL versus 49, p = 0.034). Concomitant AIDS-defining
diseases or malignancies were not associated with mortality.
Immune-reconstitution syndrome (IRS) occurred to 19 (79%) patients (8
paradoxical and 11 unmasking), and prognosis tended to be better in
unmasking-IRS than the other patients (n = 13) (p = 0.078). Patients with
paradoxical-IRS had marginally lower CD4 count and higher frequency of
bacteremia than those with unmasking-IRS (p = 0.051, and 0.059). Treatment with
systemic corticosteroids was applied in 63% and 55% of patients with
paradoxical and unmasking-IRS, respectively.
CONCLUSION:
dNTM
in HIV-infected patients resulted in high mortality even in the ART-era. NTM
bacteremia and low CD4 count were risk factors for death, whereas patients
presented with unmasking-IRS had marginally better prognosis. IRS occurred in
79% of the patients, suggesting difficulty in the management of dNTM.
Below: Patient enrollment
- 1AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
- 2Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
- PLoS One. 2016 Mar 17;11(3):e0151682. doi: 10.1371/journal.pone.0151682. eCollection 2016.
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