在高效抗逆转录病毒治疗（HAART）时代，巴西艾滋病患者中鸟分枝杆菌复合群定植发生率低，且无播散性鸟分枝杆菌复合群感染（DMAC）病例。

Low incidence of colonization and no cases of disseminated Mycobacterium avium complex infection (DMAC) in Brazilian AIDS patients in the HAART era.

作者信息

Gadelha Angela, Accácio Náurea, Grinzstejn Beatriz, Veloso Valdiléa, da Silveira Liane Braga, Fandinho Fátima, Saad Maria Helena, Lourenço Maria Cristina, Rolla Valeria

机构信息

Evandro Chagas Institute. Rio de Janeiro, Brazil.

出版信息

Braz J Infect Dis. 2002 Oct;6(5):252-7. doi: 10.1590/s1413-86702002000500006.

DOI:10.1590/s1413-86702002000500006

PMID:12495607

Abstract

OBJECTIVE

Evaluate the incidence of mycobacterial disease and the colonization of the respiratory and gastrointestinal tracts by Mycobacterium avium complex (MAC) bacteria in AIDS patients.

INCLUSION CRITERIA

HIV-positive individuals with at least one CD(4)(+) count < 100 cells/mm(3).

EXCLUSION CRITERIA

Mycobacterial disease and MAC prophylaxis. Stool, sputum, and blood cultures were prospectively obtained every month from September, 1997, to December, 1999. The incidence was calculated using Poisson regression. Survival was estimated by the Kaplan Meier method and the Cox proportional hazard model.

RESULTS

We followed-up 79 patients during a median period of 428 days. Blood cultures (n = 742) were negative for all mycobacteria. Positive cultures (25 samples) were obtained from non-sterile sites: Stools (19/703 specimens = 2.7%) and sputum (14/742 specimens = 1.9%). MAC was isolated in 7/703 stool samples (1%) and 1/32 sputum specimens (0.1%). The incidence of patient colonization with MAC was 0.09 /year (CI=0.05-0.18). CD4 counts in patients colonized with MAC were below 100 cells/mm(3) in only 2 out of 8 cases. Restoration of CD(4)(+) counts >100 cells/mm(3) (HR = 0.18; CI = 0.05-0.70) predicted a lower risk of death (P<0.05) but was not protective for MAC colonization (HR=0.52;CI =0.62-4.35, P=0.55).

CONCLUSION

The absence of DMAC infection in colonized individuals argues in favor of a HAART protective effect against; DMAC; however, restoration of CD(4) counts did not protect patients against MAC colonization.

摘要

目的

评估艾滋病患者中分枝杆菌病的发病率以及鸟分枝杆菌复合群（MAC）细菌在呼吸道和胃肠道的定植情况。

纳入标准

HIV阳性个体，且至少有一次CD4+细胞计数<100个细胞/mm³。

排除标准

患有分枝杆菌病和接受MAC预防治疗。从1997年9月至1999年12月，每月前瞻性采集粪便、痰液和血液样本进行培养。发病率采用泊松回归计算。生存情况通过Kaplan-Meier法和Cox比例风险模型进行估计。

结果

我们对79例患者进行了中位时间为428天的随访。所有分枝杆菌的血培养（n = 742）结果均为阴性。从非无菌部位获得了阳性培养样本（25份）：粪便（19/703份标本 = 2.7%）和痰液（14/742份标本 = 1.9%）。在7/703份粪便样本（1%）和1/32份痰液标本（0.1%）中分离出MAC。MAC定植患者的发病率为0.09/年（CI = 0.05 - 0.18）。在8例MAC定植患者中，仅有2例的CD4细胞计数低于100个细胞/mm³。CD4+细胞计数恢复>100个细胞/mm³（HR = 0.18；CI = 0.05 - 0.70）预示着较低的死亡风险（P<0.05），但对MAC定植没有保护作用（HR = 0.52；CI = 0.62 - 4.35，P = 0.55）。