Incidence and natural history of Mycobacterium avium-complex infections in patients with advanced human immunodeficiency virus disease treated with zidovudine

R. E. Chaisson, R. D. Moore, D. D. Richman, J. Keruly, T. Creagh, J. Bartlett, S. McAvinue, Y. Bryson, H. Cohen, M. Fischl, T. Bolin, H. Kessler, Y. Burrough, D. Mildvan, A. Fox, D. Richman, B. Freeman, G. Simon, K. W. Grabowy

Research output: Contribution to journalArticlepeer-review

Abstract

To determine the incidence and natural history of Mycobacterium avium- complex infections in persons with advanced human immunodeficiency virus (HIV) infection, we studied a multicenter cohort of 1,020 persons with acquired immunodeficiency syndrome (AIDS) or the AIDS-related complex (ARC) and CD4 cell count <0.250 x 109/L initially treated with zidovudine between April 1987 and April 1988. M. avium-complex infections developed in 123 (12%) patients during follow-up, with a 2-yr actuarial risk of 19%. Patients with an initial diagnosis of Pneumocystis carinii pneumonia were more likely to develop M. avium-complex infections than patients with an initial diagnosis of another opportunistic disease or of ARC (p = 0.002). Individuals developing M. avium-complex infections had lower baseline CD4 cell counts, hematocrits, lymphocyte counts, and total white blood cell counts than those who did not develop M. avium-complex infection. During follow-up, individuals who developed M. avium-complex infections were more likely to have severe anemia, to experience zidovudine dose reductions, and to die than were patients without M. avium-complex (p < 0.001). By proportional hazards analysis, a baseline CD4 cell count < 0.100 x 109/L, development of severe anemia, P. carinii pneumonia during follow-up, and zidovudine dose interruption were significantly associated with subsequently developing M. avium-complex infection. A proportional hazards analysis of survival showed that M. avium-complex infection, severe anemia, zidovudine dose interruption, occurrence of an opportunistic infection, CD4 cell count < 0.100 x 109/L, baseline AIDS diagnosis, and transfusion independently predicted an increased risk of death. M. avium-complex infections are a common late consequence of HIV infection, particularly in persons with low CD4 cell counts and anemia. In advanced HIV infection treated with zidovudine, M. avium-complex infection is significantly associated with the risk of death.

Original languageEnglish (US)
Pages (from-to)285-289
Number of pages5
JournalAmerican Review of Respiratory Disease
Volume146
Issue number2
DOIs
StatePublished - 1992

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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