Drug resistance and pathogenic spectrum of patients coinfected with nontuberculous mycobacteria and human-immunodeficiency virus in Chengdu, China

Abstract

Background: Human-immunodeficiency virus (HIV) infection is increasing worldwide and nontuberculous mycobacteria (NTM) is an established microbiologic cause of pulmonary disease, lymphadenitis, and disseminated disease in cases of advanced immune suppression. Data on patients coinfected with HIV and NTM are limited. Thus, this study aimed to analyze the clinical characteristics, drug resistance, and pathogen spectrum of patients coinfected with both HIV and NTM in the Chengdu area of China. Methods: Data of 59 patients coinfected with both HIV and NTM collected from the Public Health Clinical Center of Chengdu, between January 2014 and December 2018, were analyzed. NTM drug sensitivity testing was performed using the microporous plate ratio method. Data were analyzed using SPSS 19.0, and the change in drug resistance rate was analyzed using the chi-square ( χ 2 ) test. Results: Seven species/complex of NTM were identified from patients coinfected with HIV and NTM in this study, with Mycobacterium avium – intracellulare complex (52.5%) and M. kansasii (27.1%) as the predominant species. Male patients were more affected 50/59 (84.7%); the mean age of the 59 cases was 45 years. The clinical characteristics mainly included anemia (86.4%), cough and expectoration (79.7%). The baseline CD4 count was <50 cells/μL (84.7%). Patients were mainly in advanced acquired immunodeficiency syndrome (AIDS) stage. Chest imaging mainly showed patchy shadows (42.4%) and nodules (32.2%), with various degrees of AIDS-defining diseases. The drug resistance of NTM was severe, and the rate of isoniazid resistance (100.0%) was the highest, followed by rifampicin (94.9%), streptomycin (94.9%), ofloxacin (93.2%), and others. Ethambutol (52.5%) and clarithromycin (33.9%) were relatively low. No significant difference was found in the drug resistance rate of NTM strain against nine antituberculosis drugs in 5 years ( P > 0.05). Conclusions: The immune level of patients coinfected with HIV and NTM is low in advanced AIDS stage; more male are affected in patients who are mainly infected with MAC and M. kansasii and with serious drug resistance. The drug resistance rate of ethambutol and clarithromycin is relatively low.

16S and 23S rRNA Gene Mutation Independent Multidrug Resistance of Non-Tuberculous Mycobacteria Isolated from South Korean Soil

“…Our findings are consistent with previous studies indicating a high resistance rate to first-line anti-tuberculosis drugs in the NTM [70,71]. However, the resistance rates of ethambutol and rifampicin were relatively lower than that of isoniazid, which disagrees with a previous study [72].…”

Distribution of nontuberculous mycobacteria in patients with and without HIV/AIDS in Chongqing

“…In Chengdu, MAC and M. kansasii are dominant in patients with HIV/AIDS [26], consistent with the prevalence of NTM strains in Chongqing. A meta-analysis of NTM prevalence in mainland China [27] has shown that M. abscessus and M. avium are the main epidemic strains in Guangdong, consistent with the findings in Chongqing, whereas M. intracellulare and M. avium are the main epidemic strains in Beijing, Zhejiang, and Jiangsu.…”

Non-Tuberculous Mycobacterial Diseases in Children

“…To diagnose disseminated NTM infection, one or more isolates from blood, cerebrospinal fluid, bone marrow, pericardial, or peritoneal fluid is needed. They often show severe drug resistance in HIV-positive patients: a Chinese study demonstrated 100% isoniazid resistance, and 94.9% rifampicin and streptomycin resistance, with a relatively lower number of unresponsive infections treated with ethambutol (52.5%) and clarithromycin (33.9%) [31].…”