784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States

Abstract

BackgroundThe epidemiology of disseminated Mycobacterium avium complex (DMAC) infection in the United States is changing. Previously most DMAC occurred in adults with advanced AIDS. Since the development of effective antiretroviral therapy, the incidence of DMAC in AIDS has fallen more than 10-fold. Malignancy, immunosuppression, and tumor necrosis factor inhibitors are known risk factors for DMAC. We sought to describe the epidemiology of DMAC disease in HIV seronegative patients in the United States.MethodsWe performed a retrospective analysis of a commercial database (Explorys Inc., Cleveland, OH). This database contains an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to present. Explorys contains de-identified information from over 50 million patients, 360 hospitals, and over 317,000 providers. We identified a total of 571 persons diagnosed with DMAC, based on Systemized Nomenclature of Medicine-Clinical Terms. We excluded 80 HIV-infected and identified association of the infection with known risk factors.ResultsOf 570 patients, 491 HIV-uninfected patients with DMAC were studied. Underlying structural pulmonary diseases were COPD and bronchiectasis (51% and 47%, respectively). Two hundred ten patients had concomitant malignancy of which lung cancer was the most frequent (43%). Seventy-nine percent were receiving corticosteroids and 10 patients (2%) were on TNF inhibitors (2%).ConclusionIn this study, majority of patients with DMAC are HIV-uninfected. Larger studies should focus on identifying the prevalence and risk factors of DMAC in the post-AIDS era.Table: Distribution of the Sample According to Associated Conditions N = 490 (%)Age, yearsSenior (>65)330 (67%)Adult (18–65)160 (33%)Female310 (63)Smoking history420 (86)Bronchiectasis230 (47)Previous pulmonary tuberculosis40 (8)COPD250 (51)HTN310 (63)Diabetes mellitus130 (27)Chronic kidney disease110 (22)Interstitial lung disease90 (18)Inflammatory bowel disease20 (4)Concomitant malignancy210 (43)Lung60 (28)GI50 (23)Head and neck40 (19)Hematological40 (19)Renal30 (14)Chronic oral corticosteroid treatment390 (79)Tumor necrosis factor alpha inhibitor therapy10 (2)COPD; chronic obstructive pulmonary disease, HTN; hypertension, GI gastrointestinal.Disclosures All authors: No reported disclosures.