Singer J, Thorne A, Phillips P, Rachlis A R, Miller M, Gill M J, Smaill F M, Schlech W F, Senay H, Shafran S D
Canadian HIV Trials Network and the Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
AIDS. 1999 Apr 1;13(5):575-82. doi: 10.1097/00002030-199904010-00006.
To assess the importance of baseline characteristics including medical history, indicators of current disease status, therapeutic drug use, in vitro drug susceptibility, immune status and mycobacterial load on bacteriologic response and survival in HIV-positive patients with Mycobacterium avium complex (MAC) bacteremia.
An observational substudy of an open-label randomized controlled trial of two alternative therapeutic regimens for MAC.
Twenty-four hospital-based HIV clinics in 16 Canadian cities.
The main outcome measures were survival and bacteriologic response, defined by consecutive negative blood cultures for MAC at least 2 weeks apart within 16 weeks of study entry.
Prior AIDS diagnosis, low Karnofsky score, active unstable AIDS-related conditions, absence of antiretroviral therapy and absence of Pneumocystis carinii pneumonia prophylaxis were associated with shorter survival by univariate regression using the proportional hazards model. On multivariate analysis, antiretroviral therapy was not an independent predictor of mortality, and previous rifabutin prophylaxis was independently associated with poor survival outcomes, a result consistent across study treatment. Using a logistic regression model, baseline quantitative mycobacterial load [relative odds of clearing, 1.97 for a decrease of 1 log10 colony forming count; 95% confidence interval (CI), 1.36-2.87; P < 0.001] and Karnofsky score were the only statistically significant univariate predictors of clearance, although previous prophylaxis with rifabutin was also a significant predictor in a multivariate model (relative odds of clearing, 0.39; 95% CI, 0.17-0.88; P < 0.05).
This study indicates that although the level of MAC bacteremia is an important predictor of clearance, it is not associated with survival.
评估包括病史、当前疾病状态指标、治疗药物使用、体外药敏、免疫状态和分枝杆菌载量等基线特征对艾滋病病毒（HIV）阳性且患有鸟分枝杆菌复合体（MAC）菌血症患者的细菌学反应和生存情况的重要性。
一项针对MAC两种替代治疗方案的开放标签随机对照试验的观察性子研究。
加拿大16个城市的24家医院的HIV诊所。
主要观察指标为生存情况和细菌学反应，细菌学反应定义为在研究入组后16周内，至少间隔2周的连续两次MAC血培养阴性。
通过使用比例风险模型进行单变量回归分析，先前的艾滋病诊断、低卡诺夫斯基评分、活跃且不稳定的艾滋病相关病症、未接受抗逆转录病毒治疗以及未进行卡氏肺孢子虫肺炎预防与较短的生存期相关。多变量分析显示，抗逆转录病毒治疗并非死亡率的独立预测因素，而先前使用利福布汀预防与不良生存结局独立相关，这一结果在整个研究治疗过程中一致。使用逻辑回归模型，基线定量分枝杆菌载量[清除的相对比值，菌落形成计数每降低1个对数10为1.97；95%置信区间（CI），1.36 - 2.87；P < 0.001]和卡诺夫斯基评分是清除的仅有的具有统计学意义的单变量预测因素，尽管在多变量模型中先前使用利福布汀预防也是一个显著预测因素（清除的相对比值，0.39；95% CI，0.17 - 0.88；P < 0.05）。
本研究表明，虽然MAC菌血症水平是清除的重要预测因素，但它与生存情况无关。
