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Predictors of survival in patients with AIDS and disseminated Mycobacterium avium complex disease
C R Horsburgh1, B Metchock, S M Gordon
1Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia.
Abstract:
Patients with AIDS and disseminated Mycobacterium avium complex disease (DMAC), as defined by the presence of a positive blood culture for MAC, were studied retrospectively to define the natural history of DMAC. All patients had fevers, severe anemia (hematocrit < 26%), or both. Eighty-seven (76%) had signs, symptoms, or laboratory findings related to the gastrointestinal tract, but no distinct syndrome was identified. Sixty-nine patients received antimycobacterial therapy; assignment to therapy was not randomized. In a proportional hazards analysis, shorter survival was associated with higher initial level of mycobacteremia (relative risk [RR], 1.86; 95% confidence interval [CI], 1.49-2.31; P < .001), while administration of antimycobacterial chemotherapy (RR, 0.42; 95% CI, 0.26-0.70; P < .001) and antiretroviral therapy (RR, 0.40; 95% CI, 0.22-0.73; P < .01) had protective effects. Thus, the initial level of mycobacteremia of patients with DMAC may have prognostic value, and administration of antimycobacterial and antiretroviral agents may be associated with prolonged survival.
Insights
Patients with disseminated Mycobacterium avium complex (DMAC) disease often experience fever and anemia. Higher initial mycobacteremia levels correlate with shorter survival, while antimycobacterial and antiretroviral therapies show protective effects.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- Disseminated Mycobacterium avium complex (DMAC) disease is a significant opportunistic infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Understanding the natural history and prognostic factors of DMAC is crucial for managing these patients effectively.
Purpose of the Study:
- To retrospectively define the natural history of DMAC in patients with AIDS.
- To identify prognostic indicators and therapeutic effects on survival in DMAC patients.
Main Methods:
- Retrospective study of patients with AIDS and DMAC (positive blood culture for MAC).
- Analysis of clinical characteristics, including fever, anemia, and gastrointestinal symptoms.
- Proportional hazards analysis to assess the impact of mycobacteremia levels and therapies on survival.
Main Results:
- All patients presented with fever, severe anemia (hematocrit < 26%), or both.
- Gastrointestinal symptoms were common (76%), but no distinct syndrome was identified.
- Higher initial mycobacteremia levels were associated with shorter survival (RR, 1.86).
- Antimycobacterial chemotherapy (RR, 0.42) and antiretroviral therapy (RR, 0.40) demonstrated protective effects, prolonging survival.
Conclusions:
- Initial mycobacteremia level is a significant prognostic factor for patients with DMAC.
- Antimycobacterial and antiretroviral therapies are associated with improved survival in DMAC patients.
- Further research into optimizing treatment strategies for DMAC in AIDS patients is warranted.