title: Trends in nontuberculous mycobacterial disease in hospitalized subjects in Spain (1997-2010) according to HIV infection.
abstract: OBJECTIVE
  The aim of the study was to estimate the incidence of nontuberculous mycobacterial (NTM) disease and the rate of NTM disease-related mortality and to analyse trends in these variables according to HIV infection.
  
  
  METHODS
  We performed a retrospective study for the period 1997-2010 using data from the Minimum Basic Data Set (MBDS) provided by the Spanish Ministry of Health. The exposure variables were: (i) HIV infection (HIV positive versus HIV negative); (ii) calendar period in relation to widespread use of combination antiretroviral therapy (cART) [1997-1999 (early cART period), 2000-2003 (middle cART period) and 2004-2010 (late cART period)]. The outcome variables were (i) new NTM disease diagnosis and (ii) mortality.
  
  
  RESULTS
  A total of 3729 cases of incident NTM disease were collected in MBDS, 1795 in the HIV-negative group and 1934 in the HIV-positive group, among whom 602 deaths occurred, 223 in the HIV-negative group and 379 in the HIV-positive group. The incidence of NTM disease and the rate of NTM disease-related mortality were 1000-fold higher in the HIV-positive group than in the HIV-negative group. Regarding the incidence of NTM disease, in the HIV-negative group the incidence increased from 2.91 to 3.97 events per 1,000,000 patient-years from 1997-1999 to 2004-2010 (P < 0.001), while in the HIV-positive group the incidence decreased from 2.29 to 0.71 events per 1000 patient-years from 1997-1999 to 2004-2010 (P < 0.001). Regarding mortality, in the HIV-negative group mortality increased from 2.63 to 4.26 events per 10,000,000 patient-years from 1997-1999 to 2000-2003 (P = 0.059), and then the rate stabilized at around 3.87 events per 10,000,000 patient-years in 2004-2010 (P = 0.128), while in the HIV-positive group mortality decreased from 4.28 to 1.39 events per 10,000 patient-years from 1997-1999 to 2004-2010 (P < 0.001).
  
  
  CONCLUSIONS
  HIV infection was associated with a higher NTM disease incidence and higher NTM disease-related mortality than in the general population, but these rates decreased in the HIV-positive group from 1997-1999 to 2004-2010, whereas the NTM disease incidence increased in the HIV-negative group.
authors: Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain.
authors: A
authors: A
authors: Álvaro-Meca
authors: Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain.
authors: L
authors: L
authors: Rodríguez-Gijón
authors: Unit of HIV Surveillance and Behavioural Monitoring, National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain.
authors: A
authors: A
authors: Díaz
authors: Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain.
authors: Á
authors: Á
authors: Gil
authors: Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain.
authors: S
authors: http://orcid.org/0000-0001-8783-0450
authors: S
authors: Resino
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: 9th edition; AIDS; Clinical Modification (ICD-9-CM) codes; International Classification of Diseases; epidemiology; incidence; mortality; nontuberculous mycobacteria