DISSEMINATED DISEASE DUE TO MYCOBACTERIUM-AVIUM COMPLEX IN AIDS

We retrospectively analysed 46 cases of disseminated infection with My cobacterium avium complex (MAC) within a cohort of 702 HIV-infected pa tients in Edinburgh. Clinical features were compared with case-matched controls (AIDS cases without disseminated MAC), and survival and prog ression times were controlled for confounding variables that influence survival. Disseminated MAC was diagnosed antemortem in 18% of AIDS pa tients, and was the AIDS-defining diagnosis in 6% of all AIDS cases. C oncomitant colonization of respiratory and gastrointestinal tracts was common (61% and 48%, respectively). In 58% of cases, CD4+ counts were < 10 cells/mm(3) (median 6 cells/mm(3)). Weight loss, anaemia, leucop enia, and elevated liver transaminases and alkaline phosphatase were s ignificantly more common among cases than controls. Therapy was given in 74%, and not tolerated in 32%. Following AIDS diagnosis, disseminat ed MAC incidence was 14% at one year, 25% at 2 years and 36% at 3 year s. Median survival after disseminated MAC diagnosis was 6 months, with shorter survival in untreated cases. However, overall survival from A IDS diagnosis was not significantly different between patients who did or did not develop disseminated MAC. Disseminated MAC contributes sig nificantly to AIDS morbidity, and its incidence increases with prolong ed AIDS survival. Although survival following diagnosis is short, the development of disseminated MAC in AIDS probably does not affect overa ll survival. In cohorts with a low incidence, an alternative to prophy laxis might be surveillance and early diagnosis.