Clinical features and outcome in disseminated mycobacterial diseases in AIDS patients in Taiwan. 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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Clinical features and outcome in disseminated mycobacterial diseases in AIDS patients in Taiwan.

AIDS. 1998 Jul 30;12(11):1301-7. Unique Identifier : AIDSLINE MED/98372114
Hsieh SM; Hung CC; Chen MY; Hsueh PR; Chang SC; Luh KT; Department of Internal Medicine, National Taiwan University; Hospital, Taipei.

Abstract: OBJECTIVE: To describe and compare the clinical features and outcome of disseminated tuberculosis (TB) and Mycobacterium avium complex (MAC) disease in AIDS patients. DESIGN: Prospective cohort study. SETTING: A 1800-bed university teaching hospital, the largest centre for HIV/AIDS patients in Taiwan. METHODS: From July 1994 through June 1997, a standardized protocol was used to record the demographic and clinical features in all hospitalized HIV-infected patients, and to perform routine studies and invasive procedures for diagnosis of disseminated mycobacterial diseases. To compare the survival, control patients were selected from the HIV-infected patients hospitalized in the same hospital during the same study period, and had similar age, sex, CD4+ cell counts and antiretroviral therapy regimens. RESULTS: A total of 22 cases of disseminated TB and 15 cases of disseminated MAC were identified. Disseminated TB and MAC occurred in patients with similarly low CD4+ cell counts (median, 23 versus 5 x 10(6)/l; P = 0.08). The clinical features favouring disseminated TB included night sweats, peripheral lymphadenopathy, acid-fast bacilli in sputum smears, chest radiographic findings of hilar enlargement, and lack of prior AIDS-defining illnesses. Hepatosplenomegaly, elevated serum alkaline phosphatase (more than twice the upper limit of normal), elevated serum gamma-glutamyl transpeptidase (more than three times the upper limit of normal), and leukopenia favoured disseminated MAC. The patients with disseminated TB survived much longer than patients with disseminated MAC (mean survival, 96 versus 22 weeks, P = 0.008) but had a similar outcome to control patients (P = 0.60). CONCLUSION: Disseminated TB and MAC are distinguishable by clinical features in AIDS patients with similar immunocompromised states. Those features may facilitate diagnosis and selection of specific therapeutic regimens. Disseminated TB was not associated with a shortened survival period in AIDS patients when they completed anti-TB treatment. In contrast, disseminated DMAC was associated with shortened survival despite treatment with potent regimens. These results may emphasize the importance of prophylaxis for MAC in this population.
Keywords: JOURNAL ARTICLE Adolescence Adult AIDS-Related Opportunistic Infections/DIAGNOSIS/*PHYSIOPATHOLOGY Female Human HIV Long-Term Survivors Male *Mycobacterium avium Complex Mycobacterium avium-intracellulare Infection/COMPLICATIONS/ DIAGNOSIS/*PHYSIOPATHOLOGY Prospective Studies Support, Non-U.S. Gov't Taiwan Tuberculosis/COMPLICATIONS/DIAGNOSIS/*PHYSIOPATHOLOGYKWDjournalarticleadolescenceadultaids-relatedopportunisticinfections/diagnosis/KWDphysiopathologyfemalehumanhivlong-termsurvivorsmaleKWDmycobacteriumaviumcomplexmycobacteriumavium-intracellulareinfection/complications/diagnosis/KWDphysiopathologyprospectivestudiessupport,non-uKWDsKWDgov'ttaiwantuberculosis/complications/diagnosis/KWDphysiopathology
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A9911064

Copyright © 1999 - National Library of Medicine. Reproduced under license with the National Library of Medicine, Bethesda, MD.

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