High rates of disseminated infection due to non-tuberculous mycobacteria among AIDS patients in Finland

Objective: to determine the rate of disseminated infection due to non-tuber culous mycobacteria (NTM) among Finnish AIDS patients, and to analyse the e pidemiology of these infections. Methods: in a prospective cohort study HIV-infected patients with CD4 count s < 200 x 10(6)/1 were interviewed, and had mycobacterial blood cultures pe rformed at baseline and at 6 months, then subsequently for clinical indicat ions; autopsies were performed on patients who died. The cohort was followe d at least for 24 months or to death. Water samples were collected from the homes of patients and from the environment and cultured for organisms of t he Mycobacterium avium complex (MAC), Environmental and clinical isolates w ere compared using pulsed field gel electrophoresis (PFGE). Results: NTM infection occurred in 22 (43%) of 51, 19 isolates were Mycobac terium avium, two M. genavense and one M. intracellulare. Multivariate anal ysis identified urban residence (P = 0.04) and eating raw fish (P = 0.04) a s independent risk factors, Molecular analysis revealed two clusters of rel ated isolates (three M. avium, two M. genavense) among urban residents. Conclusion: AIDS patients in Finland have high rates of disseminated infect ion due to NTM, Clusters of identical organisms and association with urban residence suggests that these are newly acquired infections in advanced AID S.