PATTERNS OF MYCOBACTERIUM-AVIUM CULTURE AND PCR POSITIVITY IN IMMUNODEFICIENT HIV-INFECTED PATIENTS - PROGRESSION FROM LOCALIZED TO SYSTEMIC-DISEASE

Our aim was to establish the frequency and the longitudinal pattern of MAC culture positivity in late stage HIV-infected patients. Two other aims were to analyse risk factors for progression from localized to s ystemic disease and the value of PCR diagnosis using blood specimens, A total of 107 patients were recruited to be followed for 32 seeks. Pr ior MAC treatment and CD4 > 100/mu l were exclusion criteria. A total of 56 patients showed M., avium in at least 1 culture. 10/37 patients with MAC detected by culture first in 'non-sterile' specimens (stool, sputum) and urine progressed to systemic disease as determined by posi tive blood culture. Risk factors associated with this progression vr e re a high symptom score at baseline, lymphadenopathy, anaemia, and low platelets. PCR was less sensitive than culture in detection of M. avi um in blood specimens: Only 7/29 patients with positive blood cultures had a positive PCR at the same time. We conclude that symptomatic pat ients with advanced HIV-infection hale a high frequency of MAC detecti on. Progression from localized to systemic culture positivity is assoc iated with risk factors. Early 'pre-emptive' therapy is discussed.