Mycobacterium tuberculosis infection and disease are not associated with protection against subsequent disseminated M. avium complex disease

Timothy R. Sterling, Richard D Moore, Neil M H Graham, Jacquie Astemborski, David Vlahov, Richard E Chaisson

Research output: Contribution to journalArticle

Abstract

Objective: To determine the relationship between Mycobacterium tuberculosis infection and disease and subsequent disseminated M. avium complex (MAC) disease in HIV-infected persons. Design: A prospective observational cohort study. Setting: The AIDS Linked to the Intravenous Experience (ALIVE) cohort of injecting drug users and the Johns Hopkins Hospital Adult HIV Clinic (JHHAHC). Participants: HIV-infected persons aged > 18 years with CD4 lymphocytes <100 x 106/l were followed between July 1989 and 31 October 1996. There were 182 persons in the ALIVE cohort and 1129 persons in JHHAHC who met these criteria. Main outcome measure: The relative risk of disseminated MAC was determined according to a history of prior opportunistic infection, MAC prophylaxis, antiretroviral therapy, M. tuberculosis infection or disease, race, sex, and injecting drug use. Results: Amongst the 30 patients with active tuberculosis, eight developed disseminated MAC, compared with 208 cases of disseminated MAC amongst 1148 patients without prior M. tuberculosis infection or disease [relative risk (RR), 1.5, 95% confidence interval (CI), 0.8-2.7; P = 0.2]. Amongst the 10 patients with extrapulmonary tuberculosis, five developed disseminated MAC (RR, 2.8; 95% CI, 1.5-5.2; P = 0.02). Injecting drug use was associated with a decreased risk of disseminated MAC (RR, 0.7; 95% CI, 0.6-0.9; P = 0.007). In a logistic regression analysis, disseminated MAC was significantly associated with extrapulmonary tuberculosis and other opportunistic disease, whereas antibiotic prophylaxis and injecting drug use were protective. Conclusions: A history of M. tuberculosis infection or disease was not associated with protection against subsequent disseminated MAC disease in HIV-infected persons. However, persons with extrapulmonary tuberculosis were at increased risk for disseminated MAC, particularly at low CD4 cell levels.

Original languageEnglish (US)
Pages (from-to)1451-1457
Number of pages7
JournalAIDS
Volume12
Issue number12
DOIs
StatePublished - Aug 20 1998

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Mycobacterium Infections
Mycobacterium tuberculosis
HIV
Tuberculosis
Confidence Intervals
Acquired Immunodeficiency Syndrome
Pharmaceutical Preparations
Antibiotic Prophylaxis
Opportunistic Infections
Drug Users
Observational Studies
Cohort Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Lymphocytes

Keywords

  • Drug users
  • M. avium complex
  • Mycobacterium tuberculosis
  • Opportunistic infections

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Mycobacterium tuberculosis infection and disease are not associated with protection against subsequent disseminated M. avium complex disease. / Sterling, Timothy R.; Moore, Richard D; Graham, Neil M H; Astemborski, Jacquie; Vlahov, David; Chaisson, Richard E.

In: AIDS, Vol. 12, No. 12, 20.08.1998, p. 1451-1457.

Research output: Contribution to journalArticle

Sterling, Timothy R. ; Moore, Richard D ; Graham, Neil M H ; Astemborski, Jacquie ; Vlahov, David ; Chaisson, Richard E. / Mycobacterium tuberculosis infection and disease are not associated with protection against subsequent disseminated M. avium complex disease. In: AIDS. 1998 ; Vol. 12, No. 12. pp. 1451-1457.
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abstract = "Objective: To determine the relationship between Mycobacterium tuberculosis infection and disease and subsequent disseminated M. avium complex (MAC) disease in HIV-infected persons. Design: A prospective observational cohort study. Setting: The AIDS Linked to the Intravenous Experience (ALIVE) cohort of injecting drug users and the Johns Hopkins Hospital Adult HIV Clinic (JHHAHC). Participants: HIV-infected persons aged > 18 years with CD4 lymphocytes <100 x 106/l were followed between July 1989 and 31 October 1996. There were 182 persons in the ALIVE cohort and 1129 persons in JHHAHC who met these criteria. Main outcome measure: The relative risk of disseminated MAC was determined according to a history of prior opportunistic infection, MAC prophylaxis, antiretroviral therapy, M. tuberculosis infection or disease, race, sex, and injecting drug use. Results: Amongst the 30 patients with active tuberculosis, eight developed disseminated MAC, compared with 208 cases of disseminated MAC amongst 1148 patients without prior M. tuberculosis infection or disease [relative risk (RR), 1.5, 95{\%} confidence interval (CI), 0.8-2.7; P = 0.2]. Amongst the 10 patients with extrapulmonary tuberculosis, five developed disseminated MAC (RR, 2.8; 95{\%} CI, 1.5-5.2; P = 0.02). Injecting drug use was associated with a decreased risk of disseminated MAC (RR, 0.7; 95{\%} CI, 0.6-0.9; P = 0.007). In a logistic regression analysis, disseminated MAC was significantly associated with extrapulmonary tuberculosis and other opportunistic disease, whereas antibiotic prophylaxis and injecting drug use were protective. Conclusions: A history of M. tuberculosis infection or disease was not associated with protection against subsequent disseminated MAC disease in HIV-infected persons. However, persons with extrapulmonary tuberculosis were at increased risk for disseminated MAC, particularly at low CD4 cell levels.",
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T1 - Mycobacterium tuberculosis infection and disease are not associated with protection against subsequent disseminated M. avium complex disease

AU - Sterling, Timothy R.

AU - Moore, Richard D

AU - Graham, Neil M H

AU - Astemborski, Jacquie

AU - Vlahov, David

AU - Chaisson, Richard E

PY - 1998/8/20

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N2 - Objective: To determine the relationship between Mycobacterium tuberculosis infection and disease and subsequent disseminated M. avium complex (MAC) disease in HIV-infected persons. Design: A prospective observational cohort study. Setting: The AIDS Linked to the Intravenous Experience (ALIVE) cohort of injecting drug users and the Johns Hopkins Hospital Adult HIV Clinic (JHHAHC). Participants: HIV-infected persons aged > 18 years with CD4 lymphocytes <100 x 106/l were followed between July 1989 and 31 October 1996. There were 182 persons in the ALIVE cohort and 1129 persons in JHHAHC who met these criteria. Main outcome measure: The relative risk of disseminated MAC was determined according to a history of prior opportunistic infection, MAC prophylaxis, antiretroviral therapy, M. tuberculosis infection or disease, race, sex, and injecting drug use. Results: Amongst the 30 patients with active tuberculosis, eight developed disseminated MAC, compared with 208 cases of disseminated MAC amongst 1148 patients without prior M. tuberculosis infection or disease [relative risk (RR), 1.5, 95% confidence interval (CI), 0.8-2.7; P = 0.2]. Amongst the 10 patients with extrapulmonary tuberculosis, five developed disseminated MAC (RR, 2.8; 95% CI, 1.5-5.2; P = 0.02). Injecting drug use was associated with a decreased risk of disseminated MAC (RR, 0.7; 95% CI, 0.6-0.9; P = 0.007). In a logistic regression analysis, disseminated MAC was significantly associated with extrapulmonary tuberculosis and other opportunistic disease, whereas antibiotic prophylaxis and injecting drug use were protective. Conclusions: A history of M. tuberculosis infection or disease was not associated with protection against subsequent disseminated MAC disease in HIV-infected persons. However, persons with extrapulmonary tuberculosis were at increased risk for disseminated MAC, particularly at low CD4 cell levels.

AB - Objective: To determine the relationship between Mycobacterium tuberculosis infection and disease and subsequent disseminated M. avium complex (MAC) disease in HIV-infected persons. Design: A prospective observational cohort study. Setting: The AIDS Linked to the Intravenous Experience (ALIVE) cohort of injecting drug users and the Johns Hopkins Hospital Adult HIV Clinic (JHHAHC). Participants: HIV-infected persons aged > 18 years with CD4 lymphocytes <100 x 106/l were followed between July 1989 and 31 October 1996. There were 182 persons in the ALIVE cohort and 1129 persons in JHHAHC who met these criteria. Main outcome measure: The relative risk of disseminated MAC was determined according to a history of prior opportunistic infection, MAC prophylaxis, antiretroviral therapy, M. tuberculosis infection or disease, race, sex, and injecting drug use. Results: Amongst the 30 patients with active tuberculosis, eight developed disseminated MAC, compared with 208 cases of disseminated MAC amongst 1148 patients without prior M. tuberculosis infection or disease [relative risk (RR), 1.5, 95% confidence interval (CI), 0.8-2.7; P = 0.2]. Amongst the 10 patients with extrapulmonary tuberculosis, five developed disseminated MAC (RR, 2.8; 95% CI, 1.5-5.2; P = 0.02). Injecting drug use was associated with a decreased risk of disseminated MAC (RR, 0.7; 95% CI, 0.6-0.9; P = 0.007). In a logistic regression analysis, disseminated MAC was significantly associated with extrapulmonary tuberculosis and other opportunistic disease, whereas antibiotic prophylaxis and injecting drug use were protective. Conclusions: A history of M. tuberculosis infection or disease was not associated with protection against subsequent disseminated MAC disease in HIV-infected persons. However, persons with extrapulmonary tuberculosis were at increased risk for disseminated MAC, particularly at low CD4 cell levels.

KW - Drug users

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KW - Mycobacterium tuberculosis

KW - Opportunistic infections

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