A COMPARATIVE-STUDY OF TRANSFUSION-ACQUIRED HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN WITH AND WITHOUT DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX

For identification of the features of disseminated Mycobacterium avium complex (DMAC) in human immunodeficiency virus (HIV)-infected childre n, a retrospective medical record review of 31 long-term survivors wit h transfusion-acquired HIV was conducted. Nine patients developed DMAC defined as positive isolation of M. avium complex from peripheral blo od. DMAC was diagnosed in patients 51 to 132 months of age (mean, 101) . The time from HIV-infecting transfusion to DMAC diagnosis ranged fro m 37 to 132 months (mean, 92) and survival from the time of DMAC diagn osis ranged from 4 to 21 months (mean, 10). Selected laboratory and cl inical measures in DMAC-positive and DMAC-negative subjects were compa red. DMAC-positive patients had significantly lower CD4+ T cell counts and higher HIV p24 antigen concentrations than DMAC-negative patients at comparable times. Increased percentages of circulating leukocyte b and forms and increased aspartate aminotransferase values were seen mo re often in DMAC-positive patients. Fever and abdominal pain were the only clinical features seen more often in DMAC-positive than in DMAC-n egative patients. At the end of the study period overall survival of D MAC-positive patients was less than that of DMAC-negative children, at 33% vs. 73%. DMAC occurs in profoundly immunocompromised children wit h advanced HIV disease and significantly affects survival. The clinica l and laboratory features of DMAC are relatively nonspecific and a hig h index of suspicion in patients with markedly reduced CD4+ T cells is essential.