Herzmann C, Lange C
Klinische Infektiologie, Forschungszentrum Borstel.
Dtsch Med Wochenschr. 2010 Jun;135(23):1192-7. doi: 10.1055/s-0030-1255130. Epub 2010 May 31.
Infections with non-tuberculous mycobacteria (NTM) belong to the AIDS-defining illnesses of HIV infection. Severe immunosuppression with CD4+ lymphocyte counts lower than 50 cells/microl is a risk factor for the acquaintance of NTM infections. More than 90% of NTM infections in HIV-seropositive individuals are caused by bacteria of the M. avium complex. The manifestations of the disease are heterogeneous and not specific for the causative mycobacterial species. Furthermore, the differentiation between infection and colonisation can be challenging, especially when NTM are isolated from respiratory specimen. Diagnosis and therapy are recommended according to the guidelines of the American Thoracic Society and the Infectious Diseases Society of America (ATS/IDSA). The treatment success relies on the effects of antiretroviral therapy and a combination of 2 - 4 antimycobacterial antibiotics tailored to the NTM species. In vitro resistance testing often does not predict the clinical response. Interactions with antiretroviral medications are common. The complexity of HIV/NTM co-infection is discussed from an epidemiological, microbiological and clinical perspective.
非结核分枝杆菌（NTM）感染属于HIV感染的艾滋病界定疾病。CD4 +淋巴细胞计数低于50个细胞/微升的严重免疫抑制是发生NTM感染的危险因素。HIV血清阳性个体中超过90%的NTM感染由鸟分枝杆菌复合体细菌引起。该疾病的表现具有异质性，对致病分枝杆菌种类无特异性。此外，感染与定植之间的区分可能具有挑战性，尤其是当从呼吸道标本中分离出NTM时。建议根据美国胸科学会和美国传染病学会（ATS/IDSA）的指南进行诊断和治疗。治疗成功依赖于抗逆转录病毒疗法的效果以及针对NTM种类量身定制的2 - 4种抗分枝杆菌抗生素的联合使用。体外耐药性检测往往无法预测临床反应。与抗逆转录病毒药物的相互作用很常见。本文从流行病学、微生物学和临床角度讨论了HIV/NTM合并感染的复杂性。
