Protection from Mycobacterium avium complex disease in human immunodeficiency virus-infected persons with a history of tuberculosis.
Risk of Mycobacterium avium complex disease was examined in human immunodeficiency virus (HIV)-infected patients with and without a history of tuberculosis. Information was obtained by retrospective review of charts of patients in HIV clinics in 10 US cities. Among 1363 patients with <200 CD4 cells/mm3 seen at Grady Memorial Hospital (GMH), 11 (17%) of 66 with a history of a positive purified protein derivative (PPD) skin test acquired M. avium infection, while 29 (16%) of 185 who were PPD-negative (but not anergic) did not (P = .85). Only 4 (8%) of 49 GMH patients with a history of tuberculosis acquired M. avium infection compared with 252 (19%) of 1314 GMH patients without a history of tuberculosis (P = .05). Proportional hazards analysis of risk factors for M. avium infection among 441 persons with and 8702 persons without a history of tuberculosis in 9 other cities confirmed protection from M. avium infection in persons with a history of tuberculosis (relative risk, 0.52; 95% confidence interval, 0.36-0.76; P < .001). Prior tuberculosis provides protection against M. avium infection in HIV-infected persons, possibly by stimulation of antimycobacterial immunity.
Horsburgh
C R
CR
Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA.
Hanson
D L
DL
Jones
J L
JL
Thompson
S E
SE
D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007108:Immune Tolerance; D007110:Immunity, Active; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000276:immunology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications*