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An epidemiologic analysis of Mycobacterium avium complex disease in homosexual men infected with human
D R Hoover1, N M Graham, H Bacellar
1Johns Hopkins School of Hygiene and Public Health, Department of Epidemiology, Baltimore, Maryland 21205, USA.
Abstract:
Cofactors associated with the Mycobacterium avium complex (MAC) disease and its prognosis in incident cases of AIDS in homosexuals were studied. We compared 51 men in whom MAC disease developed as the initial AIDS-defining illness (termed AIDS illness hereafter); 157 men who had MAC disease subsequent to another AIDS illness; and 884 men who had only non-MAC AIDS illnesses. MAC disease was the initially diagnosed AIDS illness more often in Baltimore (6.9%) and Los Angeles (5.6%) than in Chicago (2.6%) and Pittsburgh (0) (P < .01). MAC disease also was a more common subsequent AIDS illness in Baltimore (14.3%) and Los Angeles (22.4%) than in Chicago (8.5%) and Pittsburgh (6.5%) (P < .0001). Prophylaxis for Pneumocystis carinii infection increased the occurrence of MAC disease as the initial AIDS illness (from 2.3% to 12.5%; P < .0001). A low white blood cell (WBC) count was slightly more predictive of MAC disease than was a low CD4+ cell count. At 0-6, 7-12, and 13-18 months before diagnosis, the WBC cell counts of 75.0%, 61.1%, and 50.0%, respectively, of those with MAC disease as the initial AIDS illness were < or = 3,400/microL. Men in whom cytomegalovirus disease developed were at higher risk for subsequent MAC disease (relative hazard = 2.65; P < .0001). MAC disease also increased the risk for subsequent cytomegalovirus disease (relative hazard = 3.96; P < .0001).
Insights
Mycobacterium avium complex (MAC) disease occurred more frequently in certain cities and was linked to Pneumocystis carinii prophylaxis. Low white blood cell counts predicted MAC disease, which also increased risk for cytomegalovirus disease.
Area of Science:
- Infectious Diseases
- Immunology
- Epidemiology
Background:
- The study investigates cofactors and prognosis of Mycobacterium avium complex (MAC) disease in individuals with Acquired Immunodeficiency Syndrome (AIDS).
- Comparisons were made between men with MAC as an initial AIDS-defining illness, MAC subsequent to another AIDS illness, and those with non-MAC AIDS illnesses.
Purpose of the Study:
- To identify factors associated with Mycobacterium avium complex (MAC) disease incidence and prognosis in homosexual men with AIDS.
- To explore the relationship between MAC disease and other AIDS-defining illnesses, including cytomegalovirus (CMV) disease.
Main Methods:
- Retrospective cohort study comparing incidence and risk factors for MAC disease across different AIDS progression pathways.
- Analysis of demographic data, prior AIDS diagnoses, prophylactic treatments, and laboratory values (WBC and CD4+ counts).
Main Results:
- MAC disease was diagnosed initially or subsequently more often in Baltimore and Los Angeles compared to Chicago and Pittsburgh.
- Prophylaxis for Pneumocystis carinii infection was associated with an increased occurrence of MAC disease as an initial AIDS diagnosis.
- Low white blood cell (WBC) count was a stronger predictor of MAC disease than low CD4+ count.
- Cytomegalovirus (CMV) disease independently increased the risk for subsequent MAC disease, and MAC disease increased the risk for subsequent CMV disease.
Conclusions:
- Geographic location and Pneumocystis carinii prophylaxis influenced MAC disease occurrence in AIDS patients.
- WBC count is a significant predictor for MAC disease, and bidirectional risk exists between MAC and CMV disease in AIDS patients.