Mycobacterium avium complex disease (MAC) in HIV patients: incidence and risk factors before and after HAART.

The objective of this study was to determine the risk factors of the first occurrence of Mycobacterium avium complex disease (MAC) infection among hum an immunodeficiency virus (HIV)-infected subjects during two different time periods: before and after the introduction of protease inhibitor (respecti vely, period 1: 1 January 1992 to 31 December 1995, and period 2: 1 January 1996 to 30 June 1998). This study was performed using the French Hospital Database on HIV(FHDH). Subjects were included when their CD4(+) cell count was less than 100/mm(3). If they did not die or develop MAC within the firs t 6 months after the inclusion, their follow-up had to be longer than 6 mon ths to be included. Cox's model was used to calculated the relative hazards (RH) of MAC occurrence according to the age and time-dependent variables, such as CD4+ below 50/mm(3), previous occurrence of tuberculosis, cytomegal ovirus (CMV) infection and other acquired immunodeficiency syndrome (AIDS)- defining disease, nature of antiretroviral treatment and MAC prophylaxis. A mong the 14,779 subjects followed during period 1, 1,710 (11.6%) had a diag nosis of MAC infection during their follow-up (incidence: 8.4 +/- 0.2 for 1 00 persons per year), while only 453 (4.4%) among 10,239 subjects presented this infection during period 2 (2.8 +/- 0,1 for 100 persons per year). Rif abutin regular prescription was a protective factor of MAC occurrence durin g period 1 (RH = 0.51 95% confidence interval (CI) = [0.37-0.69]), whereas this protective effect was not observed during period 2 (RH = 1.05 CI = [0. 63-1.67]). Thus, during the HAART period, the results that we present do no t indicate an interest into continuing MAC prophylaxis. (C) 2000 Editions s cientifiques et medicales Elsevier SAS.