G-CSF ASSOCIATION WITH PROLONGED SURVIVAL IN HIV-INFECTED PATIENTS WITH DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX INFECTION

Clarithromycin can ameliorate symptoms and improve survival in dissemi nated Mycobacterium avium complex (DMAC) infection. Optimal combinatio ns of this drug with other agents remain unknown. Granulocyte colony s timulating factor (G-CSF) is a cytokine that can improve phagocytosis of M. avium complex in vitro. We aim to determine if G-CSF administrat ion is associated with improved survival in patients with DMAC in a re trospective, cohort study. Case records from 1991 to 1995 of 91 patien ts with DMAC at Parkland Memorial Hospital were reviewed for date of i nitial DMAC diagnosis, baseline CD4 count, race, sex, antiretroviral u se, G-CSF use, therapy for DMAC (clarithromycin, ethambutol, ciproflox acin and rifabutin) and date of death. Of 91 cases identified, 25 were treated with G-CSF and 66 never received this drug. Baseline characte ristics were similar in each group including CD4 count (40 cells/mm(3) vs 33 cells/mm(3), P=0.68), clarithromycin use (18 patients vs 52 pat ients, P=0.90), and antiretroviral use (20 patients vs 42 patients, P= 0.21). Subjects heated with G-CSF Lived longer than those who did not receive this drug (355 days vs 211 days, P<0.01). In the subgroup trea ted with clarithromycin, G-CSF was also associated with increased surv ival (377 days vs 252 days, P<0.01). Cox proportional hazards model sh owed a decreased risk of death in patients treated with G-CSF (RH=0.22 , P<0.01), clarithromycin (RH=0.13, P<0.01) and ethambutol (RH=0.51, P =0.02). Ciprofloxacin and rifabutin use did not influence survival. Th ese data support the use of clarithromycin and ethambutol in the treat ment of DMAC. Addition of G-CSF to a regimen of clarithromycin and eth ambutol may increase survival in DMAC and should be studied prospectiv ely.