Mycobacterium kansasii disease among patients infected with human immunodeficiency virus type 1: improved prognosis in the era of highly active antiretroviral therapy.

OBJECTIVE

To investigate changes in survival and trends in occurrence of Mycobacterium kansasii disease in HIV-infected patients after implementation of highly active antiretroviral therapy (HAART).

METHODS

Retrospective analysis of cases of M. kansasii infection diagnosed at the Hospital Universitari de Bellvitge, Barcelona, Spain, between 1991 and 2002. As HAART was introduced at the end of 1996, the study period was divided into periods A (1991-1996) and B (1997-2002).

RESULTS

During the study period 44 cases of active M. kansasii disease were identified. The median number of cases per year was five in period A and two in period B. There were no differences in clinical presentation between the two periods. The estimated 24-month survival rate was 16% for period A and 65% for period B (P = 0.0065). Both HAART (RR 11.2; 95% CI 3.8-33.9; P < 0.001) and non-disseminated disease (RR 2.45; 95% CI 1.1-5.2; P = 0.02) were independently associated with longer survival.

CONCLUSIONS

A substantial improvement in the outcome and a fall in new cases of M. kansasii in patients infected with HIV-1 was observed in our institution, mainly as a consequence of the introduction of effective antiretroviral therapy. Antiretroviral treatment should be encouraged in these patients, even in cases of severe immunosuppression.