Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Center for Infectious Diseases, National Medical Center, Seoul, Republic of Korea.
PLoS One. 2022 Nov 10;17(11):e0276484. doi: 10.1371/journal.pone.0276484. eCollection 2022.
With the introduction of combination antiretroviral therapy (cART), the prevalence of human immunodeficiency virus (HIV)-associated nontuberculous mycobacteria (NTM) disease has declined. However, NTM diseases still occur in people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA). We analysed the clinical and microbiological features of NTM diseases in PLWHA in South Korea. PLWHA who were diagnosed with NTM diseases between January 2000 and March 2021 were retrospectively enrolled from five different hospitals in South Korea. Data on baseline demographics, HIV status, CD4+ T cell counts, viral load, past and current cART regimens, isolated NTM species, results of antimicrobial susceptibility tests, treatment regimens, and outcomes were collected by reviewing medical records. A total of 34 cases of NTM in PLWHA were included. Pulmonary and extrapulmonary NTM diseases accounted for 58.8% (n = 20) and 41.2% (n = 14), respectively. The lymph node was the most common site of extrapulmonary NTM disease (64.3%). The age at the time of NTM disease diagnosis was younger in the extrapulmonary NTM group than in the pulmonary NTM group (37.0 vs. 49.0 years). Mean CD4+ T cell counts at the time of NTM disease diagnosis was 186.6 cells/μL (range: 1-1394). Nine patients (26.5%) had fully suppressed viral loads at the time of NTM disease diagnosis. Mycobacterium avium complex (MAC) was the most common species found, followed by M. intracellulare and M. kansasii. MAC isolates were all susceptible to clarithromycin, but the rates of non-susceptibility to moxifloxacin, linezolid, ethambutol, and rifampin were 75%, 37.5%, 12.5%, and 12.5%, respectively. The average duration of treatment was 17 months and the mortality rate was 8.8%. NTM diseases may occur in PLWHA, even with completely suppressed viral loads. The identified clinical features of NTM diseases are essential for its clinical management in South Korea.
随着联合抗逆转录病毒疗法（cART）的引入，人类免疫缺陷病毒（HIV）相关非结核分枝杆菌（NTM）病的流行率有所下降。然而，HIV 相关获得性免疫缺陷综合征（AIDS）（PLWHA）患者仍会发生 NTM 病。我们分析了韩国 PLWHA 中 NTM 病的临床和微生物学特征。从韩国的五家不同医院回顾性纳入了 2000 年 1 月至 2021 年 3 月期间诊断为 NTM 病的 PLWHA。收集了基线人口统计学、HIV 状态、CD4+T 细胞计数、病毒载量、既往和当前 cART 方案、分离的 NTM 种、抗微生物药敏试验结果、治疗方案和结局的数据，通过审查病历。共纳入 34 例 PLWHA 中的 NTM 病。肺部和肺外 NTM 病分别占 58.8%（n=20）和 41.2%（n=14）。肺外 NTM 病最常见的部位是淋巴结（64.3%）。肺外 NTM 组的 NTM 病诊断年龄小于肺部 NTM 组（37.0 岁 vs. 49.0 岁）。NTM 病诊断时的平均 CD4+T 细胞计数为 186.6 个/μL（范围：1-1394）。9 例（26.5%）患者在 NTM 病诊断时病毒载量完全抑制。最常见的物种是鸟分枝杆菌复合体（MAC），其次是胞内分枝杆菌和堪萨斯分枝杆菌。MAC 分离株对克拉霉素均敏感，但对莫西沙星、利奈唑胺、乙胺丁醇和利福平的非敏感性率分别为 75%、37.5%、12.5%和 12.5%。平均治疗时间为 17 个月，死亡率为 8.8%。即使病毒载量完全抑制，PLWHA 也可能发生 NTM 病。在韩国，NTM 病的这些临床特征对其临床管理至关重要。
