CLINICAL-FEATURES AND OUTCOME IN DISSEMINATED MYCOBACTERIAL DISEASES IN AIDS PATIENTS IN TAIWAN

Objective: To describe and compare the clinical features and outcome o f disseminated tuberculosis (TB) and Mycobacterium avium complex (MAC) disease in AIDS patients. Design: Prospective cohort study. Setting: A 1800-bed university teaching hospital, the largest centre for HIV/AI DS patients in Taiwan. Methods: From July 1994 through lune 1997, a st andardized protocol was used to record the demographic and clinical fe atures in all hospitalized HIV-infected patients, and to perform routi ne studies and invasive procedures for diagnosis of disseminated mycob acterial diseases. To compare the survival, control patients were sele cted from the HIV-infected patients hospitalized in the same hospital during the same study period, and had similar age, sex, CD4+ cell coun ts and antiretroviral therapy regimens. Results: A total of 22 cases o f disseminated TB and 15 cases of disseminated MAC were identified. Di sseminated TB and MAC occurred in patients with similarly low CD4+ cel l counts (median, 23 versus 5 x 10(6)/l; P = 0.08). The clinical featu res favouring disseminated TB included night sweats, peripheral lympha denopathy, acid-fast bacilli in sputum smears, chest radiographic find ings of hilar enlargement, and lack of prior AIDS-defining illnesses. Hepatosplenomegaly, elevated serum alkaline phosphatase (more than twi ce the upper limit of normal), elevated serum gamma-glutamyl transpept idase (more than three times the upper limit of normal), and leukopeni a favoured disseminated MAC. The patients with disseminated TB survive d much longer than patients with disseminated MAC (mean survival, 96 v ersus 22 weeks, P = 0.008) but had a similar outcome to control patien ts (P = 0.60). Conclusion: Disseminated TB and MAC are distinguishable by clinical features in AIDS patients with similar immunocompromised states. Those features may facilitate diagnosis and selection of speci fic therapeutic regimens. Disseminated TB was not associated with a sh ortened survival period in AIDS patients when they completed anti-TB t reatment. In contrast, disseminated DMAC was associated with shortened survival despite treatment with potent regimens. These results may em phasize the importance of prophylaxis for MAC in this population. (C) 1998 Lippincott-Raven Publishers.