Disseminated <i>Mycobacterium avium</i> complex infection as a differential diagnosis of tuberculosis in HIV patients

Ch, Chiang; Gh, Lee; Chiang, Tsung‐Yu; Tang, P-U; Fang, Cheng-Chung

doi:10.5588/ijtld.19.0602

Cited by 6 publications

(8 citation statements)

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“…We previously developed such an algorithm, based on a combination of low CD4, low body mass index, and absence of abnormal chest radiographic findings, which had a 98% specificity in differentiating disseminated MAC infection from TB. 4 Applying aforementioned diagnostic procedure may facilitate an early decision to start life-saving anti-MAC therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] In modern ART era, disseminated MAC infections still occur in lately diagnosed HIV patients, and the associated mortality remains high. 4 However, in resource-limited countries, the role of MAC and other NTM infections in HIV-associated deaths remains unclear because of limited data mainly because of the lack of diagnostic capacity to identify NTM to species level.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Nontuberculous Mycobacterium Infections versus Tuberculosis among Autopsied HIV Patients in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Chiang

Tang

Lee

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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In industrialized countries, Mycobacterium avium complex and other nontuberculous mycobacteria (NTM) are major causes of opportunistic infection–related deaths in HIV patients. However, in resource-limited regions, data on NTM are scarce, and tuberculosis (TB) was often assumed to be the cause of death in HIV patients with a positive acid-fast smear. We searched MEDLINE and Embase databases for studies on autopsied HIV patients in sub-Saharan Africa published between January 1997 and April 2020. We included studies that reported histopathological or microbiological evidences for diagnosis of TB and NTM infection. We excluded articles without mycobacterial evidence from culture or molecular testing, such as those that used verbal autopsy, death certificates, or national registry data (systematic review registration number: CRD42019129836 at PROSPERO). We included six eligible studies that reported 391 autopsies in sub-Saharan African HIV patients. The prevalence of NTM and TB at autopsy ranged from 1.3% to 27.3% and 11.8% to 48.7%, respectively. The weighted prevalence ratio of NTM versus TB was 0.16 indicating that for every seven HIV patients died with mycobacterial infections, there was one died with NTM infection. Of the 13 NTM infections, six were caused by M. avium complex. Mycobacterium avium complex and other NTM infections are important differential diagnoses of TB at the time of death among HIV patients in sub-Saharan Africa. Our findings highlight the need to systematically survey the prevalence of NTM infections among HIV patients seeking medical care in resource-limited regions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of Nontuberculous Mycobacterium Infections versus Tuberculosis among Autopsied HIV Patients in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Chiang

Tang

Lee

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…8 In our study, the 5-year CFR for NTM was 22.6%, which appears to be more than twice as high as that of TB patients. Chiang, C-H. et al 14 also reported that PLWH with DMAC (n = 58) had a three times higher 1-year CFR than those with TB (n = 98) (48.3% vs. 16.3%). This implies that we should be more concerned about long-term prognosis of NTM in PLWH.…”

Section: Discussionmentioning

confidence: 94%

Long-Term Case-Fatality Rate of Nontuberculous Mycobacterial Disease in People Living with HIV

Shao

et al. 2021

Preprint

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Background Few data are available regarding the long-term case-fatality rate (CFR) among people living with HIV (PLWH) with nontuberculous mycobacteria (NTM) disease. Objectives To analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death. Methods A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted during January 1, 2012 to December 31, 2020 in Shanghai, China. We used Kaplan-Meier survival analysis and log-rank test to compare long-term CFR in patients with disseminated NTM (DNTM) and localized NTM disease. Univariate Cox proportional hazards regression analysis and stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR. Results The cohort was follow-up for a median of 26 months. The total CFR was 15.7% by one year and increased to 22.6% at 5 years after the diagnosis of NTM disease. The 5-year CFR of PLWH with DNTM was significantly higher than that of localized NTM (26.7% vs. 19.6% for DNTM and localized NTM disease, respectively). Older age (hazard ratio [HR] = 1.04, 95% confidence interval [CI]: 1.02-1.06, P < 0.001), comorbidity (HR = 2.05, 95% CI: 1.21-3.49, P < 0.01), DNTM (HR = 2.08, 95% CI: 1.17-3.68, P < 0.05), and HIV viral load (HR = 1.32, 95% CI: 1.12-1.55, P < 0.001) were all independent risk factors of long-term CFR. In the subgroup analysis, time to culture positivity was negatively correlated with CFR in patients with DNTM (HR = 0.90, 95% CI: 0.82-0.98, P < 0.05). Conclusions NTM was associated with significantly high long-term CFR in PLWH. Further approaches to prevent NTM disease in PLWH are urgently needed.

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“…In our study, the 5-year CFR for NTM was 22.6%, which appears to be more than twice as high as that of TB patients. Chiang et al also reported that PLWH with DMAC ( n = 58) had a three times higher 1-year CFR than those with TB ( n = 98) (48.3% vs 16.3%) [ 13 ]. This implies that the long-term prognosis of NTM in PLWH is of critical importance.…”

Section: Discussionmentioning

confidence: 99%

Long-term case-fatality rate of nontuberculous mycobacterial disease in people living with HIV

Shao

et al. 2022

Infect Dis Poverty

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Background Few data are available regarding the long-term case-fatality rate (CFR) among people living with HIV (PLWH) with nontuberculous mycobacteria (NTM) disease. The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death. Methods A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted from January 1, 2012, to December 31, 2020, in Shanghai, China. We used Kaplan–Meier survival analysis and the log-rank test to compare the long-term CFR in patients with disseminated NTM (DNTM) and localized NTM disease. Univariate Cox proportional hazards regression analysis and a stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR. Results The cohort was followed up for a median of 26 months. The total CFR was 15.7% by one year and increased to 22.6% at 5 years after the diagnosis of NTM disease. The 5-year CFR of PLWH with DNTM was significantly higher than that of PLWH with localized NTM (26.7% vs 19.6% for DNTM and localized NTM disease, respectively). Older age [hazard ratio (HR) = 1.04, 95% confidence interval (CI): 1.02–1.06, P < 0.001], comorbidity (HR = 2.05, 95% CI: 1.21–3.49, P < 0.01), DNTM (HR = 2.08, 95% CI: 1.17–3.68, P < 0.05), and HIV viral load (HR = 1.32, 95% CI: 1.12–1.55, P < 0.001) were all independent risk factors for long-term CFR. In the subgroup analysis, time to culture positivity was negatively correlated with CFR in patients with DNTM (HR = 0.90, 95% CI: 0.82–0.98, P < 0.05). Conclusions NTM was associated with a high long-term CFR in PLWH. Further approaches to prevent NTM disease in PLWH are urgently needed. Graphical Abstract

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Disseminated Mycobacterium avium complex infection as a differential diagnosis of tuberculosis in HIV patients

Cited by 6 publications

References 0 publications

Prevalence of Nontuberculous Mycobacterium Infections versus Tuberculosis among Autopsied HIV Patients in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Prevalence of Nontuberculous Mycobacterium Infections versus Tuberculosis among Autopsied HIV Patients in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Long-Term Case-Fatality Rate of Nontuberculous Mycobacterial Disease in People Living with HIV

Long-term case-fatality rate of nontuberculous mycobacterial disease in people living with HIV

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