title: Mycobacterium avium Complex Osteomyelitis in Persons With Human Immunodeficiency Virus: Case Series and Literature Review.
abstract: In persons with advanced immunosuppression, Mycobacterium avium complex (MAC) typically causes disseminated disease with systemic symptoms. We report 2 cases in which MAC caused localized osteomyelitis in human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy with rising CD4 counts. We summarize 17 additional cases of HIV-associated MAC osteomyelitis from the literature and compare CD4 count at presentation for vertebral cases versus nonvertebral cases, which reveals a significantly higher CD4 at presentation for vertebral cases (median 251 cells/µL vs 50 cells/µL; P = .043; Mann-Whitney U test). The literature review demonstrates that the majority of cases of MAC osteomyelitis, especially vertebral, occurs in individuals with CD4 counts that have increased to above 100 cells/µL on antiretroviral therapy. Among HIV-infected individuals with osteomyelitis, MAC should be considered a possible etiology, particularly in the setting of immune reconstitution.
authors.affiliation: Division of Allergy and Infectious Diseases , University of Washington , Seattle.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wood
authors.affiliation: Division of Health Sciences , Idaho State University , Pocatello.
authors.forename: Martha O
authors.initials: MO
authors.lastname: Buitrago
authors.affiliation: Samaritan Infectious Diseases , Corvallis, Oregon.
authors.forename: Sugat
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Health Sciences , Idaho State University , Pocatello.
authors.forename: David H
authors.initials: DH
authors.lastname: Hachey
authors.affiliation: Harvard School of Public Health , Boston, Massachusetts.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
authors.affiliation: Division of Allergy and Infectious Diseases , University of Washington , Seattle.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Harrington
keywords: HIV; Mycobacterium avium complex; opportunistic infections; osteomyelitis