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The international epidemiology of disseminated Mycobacterium avium complex infection in AIDS. International MAC Study

C Fordham von Reyn1, R D Arbeit, A N Tosteson

  • 1Infectious Disease Section, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.

AIDS (London, England)
|August 1, 1996
PubMed
Abstract

Insights

Disseminated Mycobacterium avium complex (MAC) infection is more common in developed countries among AIDS patients. Differences in exposure and immunity contribute to these higher rates, suggesting prevention strategies.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Public Health

Background:

  • Disseminated Mycobacterium avium complex (MAC) infection poses a significant threat to individuals with Acquired Immunodeficiency Syndrome (AIDS).
  • Understanding geographical variations in MAC infection rates is crucial for developing targeted public health interventions.
  • Factors influencing MAC susceptibility, including environmental exposure and immune status, require further investigation.

Purpose of the Study:

  • To compare the incidence of disseminated MAC infections in AIDS patients across developed and developing nations.
  • To investigate whether disparities in infection rates are attributable to differences in environmental exposure or host immunity.
  • To identify specific risk factors associated with disseminated MAC in immunocompromised individuals.

Main Methods:

  • A prospective cohort study was conducted involving 566 HIV-infected subjects with CD4 counts below 200 cells/µL.
  • Data collection included interviews, CD4 lymphocyte counts, mycobacterial blood cultures, and skin testing with purified protein derivative (PPD) and M. avium sensitin.
  • Statistical analysis, including multiple logistic regression, was employed to identify risk factors for disseminated MAC.

Main Results:

  • Disseminated MAC rates were significantly higher in developed countries (10.5-21.6%) compared to developing countries (2.4-2.6%).
  • A higher prevalence of positive PPD skin tests was observed in patients from Kenya (20%) versus other sites (1%).
  • Risk factors for disseminated MAC included low CD4 count, indoor pool swimming, bronchoscopy history, raw/partially cooked fish/shellfish consumption, and G-CSF treatment; occupational soil/water exposure showed a protective effect.

Conclusions:

  • Higher rates of disseminated MAC in AIDS patients from developed countries are linked to both increased exposure and altered immunity.
  • The findings support the development of preventive strategies, including active immunization and measures to reduce environmental exposure to MAC.
  • Further research into the interplay of exposure, immunity, and MAC infection is warranted.

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