Mycobacterium tuberculosis infection and disease are not associated with protection against subsequent disseminated M. avium complex disease. NLM AIDSLINE Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

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Mycobacterium tuberculosis infection and disease are not associated with protection against subsequent disseminated M. avium complex disease.

AIDS. 1998 Aug 20;12(12):1451-7. Unique Identifier : AIDSLINE MED/98394548
Sterling TR; Moore RD; Graham NM; Astemborski J; Vlahov D; Chaisson RE; Department of Medicine, Johns Hopkins University School of; Medicine, Baltimore, Maryland 21205, USA.

Abstract: OBJECTIVE: To determine the relationship between Mycobacterium tuberculosis infection and disease and subsequent disseminated M. avium complex (MAC) disease in HIV-infected persons. DESIGN: A prospective observational cohort study. SETTING: The AIDS Linked to the Intravenous Experience (ALIVE) cohort of injecting drug users and the Johns Hopkins Hospital Adult HIV Clinic (JHHAHC). PARTICIPANTS: HIV-infected persons aged > 18 years with CD4 lymphocytes < 100 x 10(6)/l were followed between July 1989 and 31 October 1996. There were 182 persons in the ALIVE cohort and 1129 persons in JHHAHC who met these criteria. MAIN OUTCOME MEASURE: The relative risk of disseminated MAC was determined according to a history of prior opportunistic infection, MAC prophylaxis, antiretroviral therapy, M. tuberculosis infection or disease, race, sex, and injecting drug use. RESULTS: Amongst the 30 patients with active tuberculosis, eight developed disseminated MAC, compared with 208 cases of disseminated MAC amongst 1148 patients without prior M. tuberculosis infection or disease [relative risk (RR), 1.5; 95% confidence interval (CI), 0.8-2.7; P=0.2]. Amongst the 10 patients with extrapulmonary tuberculosis, five developed disseminated MAC (RR, 2.8; 95% CI, 1.5-5.2; P=0.02). Injecting drug use was associated with a decreased risk of disseminated MAC (RR, 0.7; 95% CI, 0.6-0.9; P=0.007). In a logistic regression analysis, disseminated MAC was significantly associated with extrapulmonary tuberculosis and other opportunistic disease, whereas antibiotic prophylaxis and injecting drug use were protective. CONCLUSIONS: A history of M. tuberculosis infection or disease was not associated with protection against subsequent disseminated MAC disease in HIV-infected persons. However, persons with extrapulmonary tuberculosis were at increased risk for disseminated MAC, particularly at low CD4 cell levels.
Keywords: JOURNAL ARTICLE Adolescence Adult Antibiotic Prophylaxis Antitubercular Agents AIDS-Related Opportunistic Infections/*EPIDEMIOLOGY/IMMUNOLOGY Cohort Studies CD4 Lymphocyte Count Female Human Male Middle Age *Mycobacterium avium Complex Mycobacterium avium-intracellulare Infection/*COMPLICATIONS/ *EPIDEMIOLOGY/PREVENTION & CONTROL *Mycobacterium tuberculosis Prospective Studies Risk Factors Substance Abuse, Intravenous Support, U.S. Gov't, P.H.S. Tuberculosis/*COMPLICATIONS/*EPIDEMIOLOGY/IMMUNOLOGYKWDjournalarticleadolescenceadultantibioticprophylaxisantitubercularagentsaids-relatedopportunisticinfections/KWDepidemiology/immunologycohortstudiescd4lymphocytecountfemalehumanmalemiddleageKWDmycobacteriumaviumcomplexmycobacteriumavium-intracellulareinfection/KWDcomplications/KWDepidemiology/prevention&controlKWDmycobacteriumtuberculosisprospectivestudiesriskfactorssubstanceabuse,intravenoussupport,uKWDsKWDgov't,pKWDhKWDsKWDtuberculosis/KWDcomplications/KWDepidemiology/immunology
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