PREDICTORS OF SURVIVAL IN PATIENTS WITH AIDS AND DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX DISEASE

Patients with AIDS and disseminated Mycobacterium avium complex diseas e (DMAC), as defined by the presence of a positive blood culture for M AC, were studied retrospectively to define the natural history of DMAC . All patients had fevers, severe anemia (hematocrit <26%), or both. E ighty-seven (76%) had signs, symptoms, or laboratory findings related to the gastrointestinal tract, but no distinct syndrome was identified . Sixty-nine patients received antimycobacterial therapy; assignment t o therapy was not randomized. In a proportional hazards analysis, shor ter survival was associated with higher initial level of mycobacteremi a (relative risk [RR], 1.86; 95% confidence interval [CI], 1.49-2.31; P < .001), while administration of antimycobacterial chemotherapy (RR, 0.42; 95% CI, 0.26-0.70; P < .001) and antiretroviral therapy (RR, 0. 40; 95% CI, 0.22-0.73; P < .01) had protective effects. Thus, the init ial level of mycobacteremia of patients with DMAC may have prognostic value, and administration of antimycobacterial and antiretroviral agen ts may be associated with prolonged survival.