Mycobacterium tuberculosis infection and disease are not associated with protection against subsequent disseminated M. avium complex disease.
OBJECTIVE
To determine the relationship between Mycobacterium tuberculosis infection and disease and subsequent disseminated M. avium complex (MAC) disease in HIV-infected persons.


METHODS
A prospective observational cohort study.


METHODS
The AIDS Linked to the Intravenous Experience (ALIVE) cohort of injecting drug users and the Johns Hopkins Hospital Adult HIV Clinic (JHHAHC).


METHODS
HIV-infected persons aged > 18 years with CD4 lymphocytes < 100 x 10(6)/l were followed between July 1989 and 31 October 1996. There were 182 persons in the ALIVE cohort and 1129 persons in JHHAHC who met these criteria.


METHODS
The relative risk of disseminated MAC was determined according to a history of prior opportunistic infection, MAC prophylaxis, antiretroviral therapy, M. tuberculosis infection or disease, race, sex, and injecting drug use.


RESULTS
Amongst the 30 patients with active tuberculosis, eight developed disseminated MAC, compared with 208 cases of disseminated MAC amongst 1148 patients without prior M. tuberculosis infection or disease [relative risk (RR), 1.5; 95% confidence interval (CI), 0.8-2.7; P=0.2]. Amongst the 10 patients with extrapulmonary tuberculosis, five developed disseminated MAC (RR, 2.8; 95% CI, 1.5-5.2; P=0.02). Injecting drug use was associated with a decreased risk of disseminated MAC (RR, 0.7; 95% CI, 0.6-0.9; P=0.007). In a logistic regression analysis, disseminated MAC was significantly associated with extrapulmonary tuberculosis and other opportunistic disease, whereas antibiotic prophylaxis and injecting drug use were protective.


CONCLUSIONS
A history of M. tuberculosis infection or disease was not associated with protection against subsequent disseminated MAC disease in HIV-infected persons. However, persons with extrapulmonary tuberculosis were at increased risk for disseminated MAC, particularly at low CD4 cell levels.
Sterling
T R
TR
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Moore
R D
RD
Graham
N M
NM
Astemborski
J
J
Vlahov
D
D
Chaisson
R E
RE
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology; D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D000995:Antitubercular Agents; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control; D009169:Mycobacterium tuberculosis; D011446:Prospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology
D000995:Antitubercular Agents