Long-term case-fatality rate of nontuberculous mycobacterial disease in people living with HIV

Jingjing Hu,Yinzhong Shen,Jianjun Sun,Jun Chen,Zhenyan Wang,Junyang Yang,Renfang Zhang,Yang Tang,Ling Gu,Wei Song,Li Liu,Yueming Shao,Shuibao Xu,Tangkai Qi,Jiangrong Wang,Hongzhou Lu

doi:10.1186/s40249-022-00942-8

Abstract

BackgroundFew data are available regarding the long-term case-fatality rate (CFR) among people living with HIV (PLWH) with nontuberculous mycobacteria (NTM) disease. The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death.MethodsA retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted from January 1, 2012, to December 31, 2020, in Shanghai, China. We used Kaplan–Meier survival analysis and the log-rank test to compare the long-term CFR in patients with disseminated NTM (DNTM) and localized NTM disease. Univariate Cox proportional hazards regression analysis and a stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR.ResultsThe cohort was followed up for a median of 26 months. The total CFR was 15.7% by one year and increased to 22.6% at 5 years after the diagnosis of NTM disease. The 5-year CFR of PLWH with DNTM was significantly higher than that of PLWH with localized NTM (26.7% vs 19.6% for DNTM and localized NTM disease, respectively). Older age [hazard ratio (HR) = 1.04, 95% confidence interval (CI): 1.02–1.06, P < 0.001], comorbidity (HR = 2.05, 95% CI: 1.21–3.49, P < 0.01), DNTM (HR = 2.08, 95% CI: 1.17–3.68, P < 0.05), and HIV viral load (HR = 1.32, 95% CI: 1.12–1.55, P < 0.001) were all independent risk factors for long-term CFR. In the subgroup analysis, time to culture positivity was negatively correlated with CFR in patients with DNTM (HR = 0.90, 95% CI: 0.82–0.98, P < 0.05).ConclusionsNTM was associated with a high long-term CFR in PLWH. Further approaches to prevent NTM disease in PLWH are urgently needed.Graphical

Highlights

Few data are available regarding the long-term case-fatality rate (CFR) among people living with Human immunodeficiency virus (HIV) (PLWH) with nontuberculous mycobacteria (NTM) disease
Since the antiretroviral therapy (ART) era, AIDS has become a chronic disease, which has led to a significant increase in life expectancy in people living with HIV (PLWH), and the incidence of disseminated Mycobacterium avium complex (DMAC) has declined significantly from 65.3/1,000 in 1992 to 2.0/1,000 in 2015 [6]
The inclusion criteria were as follows: (1) HIV-1 infection confirmed by Western blotting; (2) patients had at least one specimen with positive mycobacterial culture and negative for MPB64, or the mycobacterial sequencing results were NTM; (3) physicians deemed NTM to be an etiology of the diseases but not colonization

Summary

Introduction

Few data are available regarding the long-term case-fatality rate (CFR) among people living with HIV (PLWH) with nontuberculous mycobacteria (NTM) disease. The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death. Nontuberculous mycobacteria (NTM) disease is one of the leading opportunistic infections in people living with HIV (PLWH). 37 cases of disseminated NTM (DNTM) were identified in 7,349 patients in Oregon, USA, between 2007 and 2012, with a median annual incidence of 110/100,000 HIV personyears and the highest incidence in those with C D4+ T cell count < 50 cells/mm (5,300/100,000 person-years) [4]. In the preantiretroviral therapy era, case fatality rates (CFRs) were high for NTM and even higher for DNTM, with an annual CFR of 71% [5]. Despite the availability of effective ART, the CFR for NTM remains high, with a CFR of 69% at 1 year and 27% at 3 years after the diagnosis of DMAC [7]

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