EARLY MANIFESTATIONS OF DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX DISEASE - A PROSPECTIVE EVALUATION

A nested case-control study was conducted in two trials of prophylaxis for Mycobacterium avium complex (ILIAC) infection to describe the spe cific signs, symptoms, and laboratory abnormalities of MAC disease in AIDS, Patients had less than or equal to 200/mm(3) CD4 cells and a pri or AIDS-defining illness. Of 571 patients, 102 (17.9%) developed MAC b acteremia during a mean follow-up of 256 days, Among cases of MAC dise ase, 90 were compared with 180 matched controls, Patients with MAC dis ease were more likely than controls to have lower weights (66.3 vs. 71 .1 kg, P = .001) and Karnofsky scores (74.3 vs. 84.4, P < .001): a hig her proportion had fever (48% vs. 26%, P = .003), abdominal pain (23% vs. 13%, P = .05), decreased hemoglobin levels (10.9 vs. 12.1 g/dL, P < .001), and elevated alkaline phosphatase (203 vs, 138 U/L, P = .04) and lactate dehydrogenase (334 us, 280 U/L, P = .02) levels, Character istics of MAC disease that occurred before bacteremia were weight loss (3 months prior), fever (2 months), and anemia and elevated lactate d ehydrogenase tl month), These data suggest that patients have symptoma tic MAC disease for several months prior to the occurrence of bacterem ia.