title: The impact of HIV infection on Mycobacterium kansasii disease in South African gold miners.
abstract: The impact of human immunodeficiency virus (HIV) infection on Mycobacterium kansasii disease in miners was investigated with a retrospective study covering a single workforce. M. kansasii, isolated from 43 HIV-positive and 202 HIV-negative miners, was the most common nontuberculous mycobacterial (NTM) species in both HIV groups. CD4 counts were unusually high for M. kansasii disease (mean 490 x 10(6)/L, from 14 HIV-positive men). Treatment outcomes were similar: mortality during treatment was higher in HIV-positive than in HIV-negative men (9% and 2%, respectively), but not significantly so. The majority of a sample of 31 HIV-positive and 92 HIV-negative men had radiological silicosis and/or old tuberculosis scarring prior to M. kansasii disease. A normal premorbid radiograph was more common in HIV-positive men (45% versus 24%; odds ratio [OR], 2.62; 95% confidence interval [95% CI], 1.01 to 6.67). New cavitation was less common (55% versus 78%; OR, 0.34; 95% CI, 0.13 to 0.88) and new hilar adenopathy more common (OR, 5.07; 95% CI, 1.24 to 21.9) in HIV-positive than in HIV-negative men. Miners, who have additional NTM risk factors, develop M. kansasii disease that occurs at an earlier stage of HIV infection and more closely resembles disease in HIV-negative men than has been found for HIV-associated M. kansasii disease in other settings.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. liz@pegasus.marques.co.za
authors.forename: E L
authors.initials: EL
authors.lastname: Corbett
authors.forename: G J
authors.initials: GJ
authors.lastname: Churchyard
authors.forename: M
authors.initials: M
authors.lastname: Hay
authors.forename: P
authors.initials: P
authors.lastname: Herselman
authors.forename: T
authors.initials: T
authors.lastname: Clayton
authors.forename: B
authors.initials: B
authors.lastname: Williams
authors.forename: R
authors.initials: R
authors.lastname: Hayes
authors.forename: D
authors.initials: D
authors.lastname: Mulder
authors.forename: K M
authors.initials: KM
authors.lastname: De Cock
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000401:mortality; D000328:Adult; D015897:Comorbidity; D005500:Follow-Up Studies; D006046:Gold; D006679:HIV Seropositivity / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008906:Mining; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000401:mortality; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000401:mortality; D019909:Mycobacterium kansasii / Q000302:isolation & purification; D009784:Occupational Diseases / Q000175:diagnosis* / Q000401:mortality; D011009:Pneumoconiosis / Q000175:diagnosis / Q000401:mortality; D012307:Risk Factors; D013019:South Africa; D015996:Survival Rate; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000401:mortality
chemical_list: D006046:Gold