Mycobacterial lymphadenitis associated with the initiation of combination antiretroviral therapy.
OBJECTIVE
To characterize the impact of combination antiretroviral therapy on the clinical and laboratory features of mycobacterial lymphadenitis, we conducted a retrospective chart review of HIV-related mycobacterial lymphadenitis at St. Paul's hospital between 1989 and 1997. Among 52 evaluable patients, 12 presented within 12 weeks of initiating combination antiretroviral therapy (group 1, n = 12); the others developed lesions while receiving no antiretrovirals, monotherapy, or a stable combination regimen of >12 weeks duration (group 2, n = 40).


RESULTS
Group 1 patients had higher absolute CD4 lymphocyte counts (median, 150 versus 20 cells/mm3, respectively; p = .001) and hemoglobin levels (median, 113 versus 88 g/L, respectively; p = .002) at the time of mycobacterial diagnosis. Clinical comparison showed that group 1 patients were more likely to develop a draining sinus (50% versus 0%; p < .001), but less often to have weight loss (17% versus 74%; p < .0001) or disease which was disseminated (25% versus 70%; p = .04) or caused by Mycobacterium tuberculosis (0% versus 33%; p = .04).


CONCLUSIONS
Mycobacterial lymphadenitis developing within 12 weeks of initiating combination antiretroviral therapy is often localized Mycobacterium avium complex disease, associated with a relatively high CD4 count. The clinical course is often complicated by the development of a draining sinus. The close temporal association suggests that such treatment may unmask subclinical infection by enhancing the immune response to mycobacterial antigens.
AIDS Research Program, Division of Infectious Diseases, St. Paul's Hospital and the University of British Columbia, Vancouver, Canada. pphils@hivnet.ubc.ca
P
P
Phillips
M B
MB
Kwiatkowski
M
M
Copland
K
K
Craib
J
J
Montaner
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D008199:Lymphadenitis / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000209:etiology; D013997:Time Factors
D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents