Predictors of survival in patients with AIDS and disseminated Mycobacterium avium complex disease.
Patients with AIDS and disseminated Mycobacterium avium complex disease (DMAC), as defined by the presence of a positive blood culture for MAC, were studied retrospectively to define the natural history of DMAC. All patients had fevers, severe anemia (hematocrit < 26%), or both. Eighty-seven (76%) had signs, symptoms, or laboratory findings related to the gastrointestinal tract, but no distinct syndrome was identified. Sixty-nine patients received antimycobacterial therapy; assignment to therapy was not randomized. In a proportional hazards analysis, shorter survival was associated with higher initial level of mycobacteremia (relative risk [RR], 1.86; 95% confidence interval [CI], 1.49-2.31; P < .001), while administration of antimycobacterial chemotherapy (RR, 0.42; 95% CI, 0.26-0.70; P < .001) and antiretroviral therapy (RR, 0.40; 95% CI, 0.22-0.73; P < .01) had protective effects. Thus, the initial level of mycobacteremia of patients with DMAC may have prognostic value, and administration of antimycobacterial and antiretroviral agents may be associated with prolonged survival.
Horsburgh
C R
CR
Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia.
Metchock
B
B
Gordon
S M
SM
Havlik
J A
JA
McGowan
J E
JE
Thompson
S E
SE
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality* / Q000503:physiopathology; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D015270:Mycobacterium avium-intracellulare Infection / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate
D000900:Anti-Bacterial Agents