Mycobacterium kansasii in HIV patients: clarithromycin and antiretroviral effects.
METHODS
Charity Hospital New Orleans, Louisiana, USA.


OBJECTIVE
To define the differences between the pre-HAART (highly active anti-retroviral treatment) and HAART eras in patients co-infected with Mycobacterium kansasii and the human immunodeficiency virus (HIV).


METHODS
A retrospective chart review revealed 82 patients with HIV and M. kansasii during the 6-year period from 1 July 1991 to 30 June 1997 (pre-HAART era), while the 6-year period from 1 July 1997 to 30 June 2003 (HAART era) revealed 55 cases.


RESULTS
Among all patients with M. kansasii and HIV, 47 (34%) had an additional, concurrent mycobacterial infection and two had triple mycobacterial species isolation. More patients (17/82, 21%) had disseminated mycobacterial disease in the pre-HAART era than in the HAART era (3/55, 5%; P = 0.045). Pre-HAART patients treated without clarithromycin (CLM) survived a median of 2 months vs. 10 months for pre-HAART patients treated with CLM (P = 0.05). Those treated without CLM had a median survival of 2 months in the pre-HAART era (n = 19) vs. 10.5 months in the HAART era (n = 12, P < 0.02).


CONCLUSIONS
CLM use in treatment of M. kansasii in HIV-co-infected patients is associated with significantly longer survival.
Tompkins
J C
JC
Infectious Diseases Section, Tulane University Health Sciences Center, New Orleans, Louisiana, USA. jtompkins@swmc.org
Witzig
R S
RS
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017291:Clarithromycin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000453:epidemiology; D019909:Mycobacterium kansasii / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D017291:Clarithromycin