Work

Incidence and Long-Term Outcomes of Patients With Human Immunodeficiency Virus and Disseminated Mycobacterium avium Complex From 1992 to 2015

Year: 2016

Type: article

Abstract: Background. The availability of highly active antiretroviral therapy (HAART) has dramatically changed the natural history of human immunodeficiency virus (HIV) infection, including improved overall survival. However, late-stage complications, such as disseminated Mycobacterium avium complex (DMAC) infection, continue to occur. Methods. We examined a retrospective cohort of HIV-infected patients presenting with DMAC that included all patients initially diagnosed at our center between 1992 and 2015. Data were extracted using a systematic query of the electronic medical record, supplemented by manual record review. Results. We identified 331 adult HIV-infected patients newly diagnosed with DMAC from 1992–2015. The majority of patients were male (75.2%) and non-Hispanic black (69.2%), with a median age of 37 years (interquartile range = 31–43 years, range 19–71). The incidence of DMAC declined from a peak of 65.3/1000 in 1992 to 1.0/1000 in 2015 as shown in Figure 1. More than half of the patients (n = 181) were never started on HAART, including 46 diagnosed in the post-HAART era (1996 and later). Of those prescribed HAART, 84 patients had received prescriptions prior to the time of DMAC diagnosis, 32 were newly started on HAART within 30 days of DMAC diagnosis, 17 within 31–180 days, and 14 after 180 days. Three patients had unknown prescription status. Median follow-up time after diagnosis was 262 days (IQR = 83–574 days, range 0–5334), resulting in 574.8 total patient-years of follow-up. Median survival was 189 days in patients who never started HAART (95% CI 140–255 days), but the median survival was not reached (60% still alive) among patients who received HAART (Figure 2) after a median 455 days of follow-up. A significant number had documented long-term survival, with 37 of 150 (25%) patients known to be alive at five years post-DMAC and 10 (7%) alive at 10 years post-DMAC diagnosis. Conclusion. DMAC has become significantly less common over time but despite widespread availability of effective antiretroviral therapy, patients still present with this late-stage complication of HIV. HAART is associated with reasonably good survival in these patients even when initiated relatively late after DMAC diagnosis. Disclosures. M. Clement, UpToDate: Section Author, Licensing agreement or royalty

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.442

Authors: Lauren Collins, Meredith Clement, Jason Stout

Institution: Duke Medical Center

Language: English

Topic: Mycobacterium research and diagnosis

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053