Incidence and natural history of Mycobacterium avium-complex infections in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group.
To determine the incidence and natural history of Mycobacterium avium-complex infections in persons with advanced human immunodeficiency virus (HIV) infection, we studied a multicenter cohort of 1,020 persons with acquired immunodeficiency syndrome (AIDS) or the AIDS-related complex (ARC) and CD4 cell count < 0.250 x 10(9)/L initially treated with zidovudine between April 1987 and April 1988. M. avium-complex infections developed in 123 (12%) patients during follow-up, with a 2-yr actuarial risk of 19%. Patients with an initial diagnosis of Pneumocystis carinii pneumonia were more likely to develop M. avium-complex infections than patients with an initial diagnosis of another opportunistic disease or of ARC (p = 0.002). Individuals developing M. avium-complex infections had lower baseline CD4 cell counts, hematocrits, lymphocyte counts, and total white blood cell counts than those who did not develop M. avium-complex infection. During follow-up, individuals who developed M. avium-complex infections were more likely to have severe anemia, to experience zidovudine dose reductions, and to die than were patients without M. avium-complex (p < 0.001). By proportional hazards analysis, a baseline CD4 cell count < 0.100 x 10(9)/L, development of severe anemia, P. carinii pneumonia during follow-up, and zidovudine dose interruption were significantly associated with subsequently developing M. avium-complex infection. A proportional hazards analysis of survival showed that M. avium-complex infection, severe anemia, zidovudine dose interruption, occurrence of an opportunistic infection, CD4 cell count < 0.100 x 10(9)/L, baseline AIDS diagnosis, and transfusion independently predicted an increased risk of death.(ABSTRACT TRUNCATED AT 250 WORDS)
Chaisson
R E
RE
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Moore
R D
RD
Richman
D D
DD
Keruly
J
J
Creagh
T
T
D000386:AIDS-Related Complex / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D000206:Actuarial Analysis; D000740:Anemia / Q000145:classification / Q000150:complications; D001803:Blood Transfusion; D015496:CD4-Positive T-Lymphocytes; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D011020:Pneumonia, Pneumocystis / Q000150:complications; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D044469:Racial Groups; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D015215:Zidovudine / Q000008:administration & dosage / Q000627:therapeutic use
D015215:Zidovudine