DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX INFECTION IN AIDS - IMMUNOPATHOGENIC SIGNIFICANCE OF AN ACTIVATED TUMOR-NECROSIS-FACTOR SYSTEM ANDDEPRESSED SERUM LEVELS OF 1,25-DIHYDROXYVITAMIN-D

Disseminated Mycobacterium avium complex (MAC) infection is associated with considerable morbidity and mortality in patients with AIDS. Beca use both tumor necrosis factor-alpha (TNF-alpha) and 1,25-dihydroxyvit amin D-3 (1,25D) may be involved in the normal control of MAC infectio n, these parameters were studied in AIDS patients with disseminated MA C infection. Of 53 AIDS patients studied, 24 had no clinical events, 1 1 had disseminated MAC infection, and 18 had other clinical events. Pa tients with disseminated MAC infection had significantly higher serum levels of both TNF-alpha and soluble TNF receptors compared with other AIDS patients; almost half of the MAC-infected patients had TNF bioac tivity in serum, MAC-infected patients also had severely decreased ser um 1,25D levels compared with all other AIDS patients. The activation of the TNF system was significantly correlated with the degree of 1,25 D deficiency. These findings may reflect interaction between vitamin D and the TNF system in the pathophysiology of disseminated MAC infecti on in AIDS.