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Volume 37, Number 1, February 2004

Discontinuation of secondary prophylaxis in AIDS patients with disseminated non-tuberculous mycobacteria infection


Chung-Hsin Liao, Mao-Yuan Chen, Szu-Min Hsieh, Wang-Hwei Sheng, Chien-Ching Hung, Shan-Chwen Chang
Department of Internal Medicine, National Taiwan University Hospital, Taipei; and Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan, ROC

Received: February 14, 2003    Revised: June 25, 2003    Accepted: July 3, 2003   

 

Corresponding author:

Chien-Ching Hung, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan 100, ROC. E-mail: hcc0401@ha.mc.ntu.edu.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Methods:

From June 1994 to June 2002, disseminated infections due to non-tuberculous mycobacteria (NTM) were diagnosed in 42 of 716 (5.9%) non-haemophiliac HIV-infected patients aged >15 years who were treated at National Taiwan University Hospital. The median age of these patients was 35 years (range, 27 to 60 years). The median CD4+ cell count and plasma viral load at the time of diagnosis of disseminated NTM infections were 8×106/L (range, 0 to 892 ×106/L) and 37,600 copies/mL (range, <400 to >750,000 copies/mL), respectively. The nadir CD4+ count during the observation period was 6 × 106/L (range, 0 to 30 × 106/L). The species of NTM isolated included Mycobacterium avium complex (MAC) [n = 35], Mycobacterium kansasii (4), Mycobacterium chelonae (1), Mycobacterium abscessus (1), and unidentified NTM (3). Co-infection with 2 species of NTM was diagnosed in 2 patients. NTMs were isolated from blood (n = 18), liver (18), lymph node (12), bone marrow (10), cerebral spinal fluid (1), ascites (1), and pericardial effusion (1). The median duration of antimycobacterial therapy of the 42 patients was 7 months (range, 0 to 24 months). Mortality during the study period was greater in the patients enrolled before highly active antiretroviral therapy (HAART) was introduced (14 of 15, 93%) than in those who received HAART (9 of 27, 33%). As of December 31, 2002, 15 patients (35.7%) had discontinued secondary prophylaxis against disseminated NTM infections when their median CD4+ count had increased to 119 ×106/L (range, 25 to 465 ×106/L), and 86.7% (13/15) of the patients had achieved an undetectable plasma viral load after HAART. During the median observation duration of 12 months (range, 2 to 57 months), none of the 15 patients had relapse of disseminated NTM infections. Our findings indicate that disseminated NTM infections without primary prophylaxis were associated with a high mortality rate, especially before HAART became available. In patients who received HAART and had a favorable response with viral suppression and immune restoration, discontinuation of secondary prophylaxis against disseminated NTM infections was safe.



 

Key words:

AIDS, highly active antiretroviral therapy, Mycobacterium avium complex, Mycobacterium kansasii, non-tuberculous mycobacteria, prophylaxis



 



 

J Microbiol Immunol Infect 2004;37:50-56.