Impact of highly active antiretroviral therapy on onset of Mycobacterium avium complex infection and cytomegalovirus disease in patients with AIDS

Objectives: To assess the impact of highly active antiretroviral therapy (H AART) on the onset of first disseminated Mycobacterium avium complex (MAC) infection and first cytomegalovirus (CMV) disease episode in HIV-infected a t-risk patients. Methods: The incidence of the two infections occurring in at-risk patients was calculated for two periods (January 1995-June 1996 and July 1996-Decemb er 1997) using the database of the HIV-infected patients followed in the In fectious Diseases Department at the Pitie-Salpetriere Hospital in Paris. HA ART was progressively introduced in late June 1996 in France. Results: A total of 91 first disseminated MAC infections and 124 first CMV disease episodes were recorded. The incidence of first disseminated MAC inf ections fell from 13.4 per 100 person-years in the first 18-month period to 2.6 per 100 person-years in the second 18-month period. Similarly, the inc idence of first CMV disease episodes fell from 20.9 to 3.5 per 100 person-y ears. Fourteen patients on HAART developed a first MAC infection, 12 (85.7% ) within 2 months of starting HAART. Nineteen patients on HAART had a first CMV disease episode, 10 (52.6%) within 2 months of starting HAART. Conclusions: HAART led to a five-fold decrease in the incidence of first di sseminated MAC infections and a six-fold decrease in first CMV disease epis odes, although patients remain vulnerable to both diseases for approximatel y 2 months after starting HAART. (C) 2000 Lippincott Williams & Wilkins.