Disseminated disease due to non-tuberculous mycobacteria in HIV positive patients: a retrospective case control study

  • Introduction Disseminated infection due to non-tuberculous mycobacteria has been a major factor of mortality and comorbidity in HIV patients. Until 2018, U.S. American guidelines have recommended antimycobacterial prophylaxis in patients with low CD4 cell counts, a practice that has not been adopted in Europe. This study aimed at examining the impact of disseminated NTM disease on clinical outcome in German HIV patients with a severe immunodeficiency. Materials and methods In this retrospective case control study, HIV patients with disseminated NTM disease were identified by retrospective chart review and matched by their CD4 cell counts to HIV patients without NTM infection in a 1:1 alocation. Primary endpoints were mortality and time to first rehospitalisation. In addition, other opportunistic diseases, as well as antimycobacterial and antiretroviral treatments were examined. Results Between 2006 and 2016, we identified 37 HIV patients with disseminated NTM disease. Most of them were suffering from infections due to M. avium complex (n = 31, 77.5%). Time to event analysis showed a non-significant trend to higher mortality in patients with disseminated NTM disease (p = 0.24). Rehospitalisation took place significantly earlier in patients with disseminated NTM infections (median 40.5 days vs. 109 days, p<0.0001). Conclusion In this retrospective case control study, we could demonstrate that mortality is not significantly higher in HIV patients with disseminated NTM disease in the ART era, but that they require specialised medical attention in the first months following discharge.

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Author:Nils WetzsteinORCiDGND, Ari Geil, Gerrit KannGND, Annette LehnORCiDGND, Gundolf SchüttfortORCiDGND, Johanna KesselGND, Tobias Michael BingoldORCiDGND, Claus Philippe Küpper-TetzeORCiD, Annette Haberl, Christiana Graf, Maria J. G. T. VehreschildORCiDGND, Christoph StephanORCiDGND, Michael HogardtORCiDGND, Thomas Alexander Wichelhaus, Timo WolfORCiDGND
Parent Title (English):PLOS ONE
Place of publication:San Francisco, California, US
Document Type:Article
Date of Publication (online):2021/07/13
Date of first Publication:2021/07/13
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2021/10/14
Tag:Antiretroviral therapy; HIV; Mycobacteria; Mycobacterium avium complex; Nontuberculous mycobacteria; Opportunistic infections; Protease inhibitor therapy; Respiratory infections
Issue:7, art. e0254607
Page Number:13
First Page:1
Last Page:13
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0