ISOLATION OF MYCOBACTERIA FROM PATIENTS SEROPOSITIVE FOR THE HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) IN SOUTH EAST ENGLAND - 1984-92

Background-Tuberculosis and other mycobacterial infections are well re cognised complications of HIV infection and surveillance is thus requi red. Methods-All mycobacteria isolated from HIV positive subjects and referred to the Public Health Laboratory Service South East Regional T uberculosis Centre (SERTC) from the first such case in 1984 until the end of 1992 were reviewed. Results-A total of 803 mycobacteria isolate d from 727 HIV positive subjects were referred to the SERTC during the study period. A single species was isolated from 660 patients: 150 me mbers of the tuberculosis complex (146 M tuberculosis, two M bovis, an d two M africanum), 356 M avium-intracellulare (MAI), and 154 other en vironmental mycobacteria. More than one mycobacterium was isolated fro m 67 patients. In 12 cases M tuberculosis and MAI were isolated from t he same patient, almost always in that sequence, with an interval of 8 -41 months between isolations. Most of the 407 isolates of MAI (74%) w ere considered to be clinically significant and often caused dissemina ted disease. In other cases single isolates of MAI were obtained from sputum or faeces and occasionally such isolates preceded disseminated disease by several months. Only 33 (14%) of the 229 isolates of enviro nmental mycobacteria other than MAI were considered clinically signifi cant. Conclusions-HIV related mycobacterial disease is increasing in i ncidence in south east England. Further studies are required to determ ine the significance of single isolates of MAI and other environmental mycobacteria as a guide to the need for preventive chemotherapy or im munotherapy.