Nontuberculous mycobacterial infection in people living with HIV | Infectious diseases of poverty

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Characteristics of the research population

Three hundred and seventy -nine patients were included. Of this, 93.7% were male, and the median age was 38.0 (IQR: 30.0–50.0) years. In total, 7.4% of patients were current or former smokers, and 2.6% drank alcohol. One hundred and thirteen patients (29.8%) had opportunistic disorders, and 136 patients (35.9%) had opportunistic disorders. Also, the median CD4+ The cellular T / μl value was 23.0 (IQR: 6.0–73.8), and the median HIV viral load was 4.84 (IQR: 1.9–5.5) log10 copies / ml. Two hundred and ninety-four patients (77.6%) received ART before anti-NTM therapy, and the median time from the start of ART to the start of anti-NTM therapy was 31.0 (IQR: 4.0–127.0) months (Table 1).

Table 1 Basic features of PLWH with NTM disease

The most common symptom was fever (63.4%). Cough was reported in 44.1% of all cases. 22.8% reported HIV infection, 18.3% reported abdominal pain and / or diarrhea, 12.9% reported central nervous system symptoms such as headache and dizziness, and half of these diseases are associated with cryptococcal meningitis. The remaining 11.6% of patients had skin manifestations, such as rashes (Table 1). For each year from 2013 to 2020, DNTM accounted for about half of the total NTM in PLWH (Fig. 1). Among the positive symptoms previously reported, sputum accounted for 60.7%; Blood pressure was 23.5%; and 6.9% stool; and the remainder were puncture fluid (4.0%), bronchoalveolar lavage or bronchial lavage fluid (1.3%), pleural effusion (0.8%), cerebrospinal fluid (0.8%), bone marrow (0.8%), urine (0.5%), hydroperitoneum (0.3%), abdominal abscess (0.3%) and secretions from the gastrointestinal tract (0.3%). The median time of cultural positivity was 13.9 (IQR: 9.5–23.5) days.

Fig. 1
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PLWH courses are matched with distributed NTM and local NTM disease. (The data shown in the charts are percentages and numbers). PLWH people living with HIV, NTM nontuberculous mycobacteria

Three hundred and twenty -six (86.0%) patients received CT scans. Of the 326, 148 (45.4%) patients reported lymphadenopathy. The usual morphology was mediastinal lymphadenopathy (128/148, 86.5%) (Table 2).

Table 2 Radiology findings of PLWH with NTM disease

Treatment for NTM patients consists of a multidrug regimen and a long -term course of medication. The anti-NTM medications for the patients included macrolides, levofloxacin/moxifloxacin, ethambutol, rifampicin/rifabutin, and linezolid (Table 1), which lasted for 9–12 months. Almost all patients are treated with ART.

A look at life

After a median of 26 months of follow -up, 69 patients (18.2%) died, and 48 (12.7%) were missing from follow -up. In 52.2% of patients, the follow -up period was longer than 2 years. The life expectancy reported an overall CFR of 15.7% at 1 year, 19.0% at 2 years, 20.0% at 3 years, 22.6% at 5 years, and 27.9% at 7 years. Univariate Cox regression analysis showed that the following components were important for survival: aging, HIV viral load, ART rather than treatment with NTM, comorbidity, linezolid and DNTM (Table 3). The mortality rate in PLWH with NTM increased with time (Fig. 2).

Table 3 Hazard ratio by univariate analysis and multivariate analysis
Fig. 2
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Mortality (95% confidence interval) between PLWH and NTM. PLWH people living with HIV, NTM nontuberculous mycobacteria

Thinking of that woman, smoking, drinking, opportunistic disease, CD4+ The T cell number, as well as time to culture positivity are some of the major risk factors, and these factors and regions that are critical to the univariate number were included in the multivariate Cox proportional hazards model. The results showed a risk ratio of 2.05 [95% confidence interval (CI): 1.21–3.49, P < 0.01] for patients with chronic diseases compared with those without chronic diseases. The risk of injury caused by old age is 1.04 (95% MAILA: 1.02–1.06, P<0.001). High levels of viral load were significant in the score, with a mortality ratio of 1.32 (95%). MAILA: 1.12–1.55, P<0.001). DNTM was significantly associated with poor health outcomes (HR = 2.08, 95% MAILA : 1.17–3.68, P <0.05) (Table 3). The Kaplan-Meier analysis also showed that the long-term CFR of the DNTM group was higher than that of the localized disease group (Fig. 3). Surprisingly, patients not treated with linezolid had a longer life expectancy than those treated with linezolid (HR = 4.71, 95%). MAILA: 2.25–9.83, P<0.001).

Figure 3
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Mortality is found among PLWH with disseminated NTM and localized NTM disease. PLWHpeople living with HIV, NTMnontuberculous mycobacteria

In addition, we performed a screening stratified by baseline CD4+ T cell count. Patients with CD4+ The CFR was 7.9%, 12.1%, and 17.9%at 1, 3, and 7 years of age 1, 3, and 7 with mean T cell count> 50 cell/μl. Old age (HR = 1.09, 95% MAILA: 1.04–1.14, P<0.001) and DNTM (HR = 3.52, 95% MAILA : 1.01–12.28, P<0.05) are independent prognostic factors. Patients with CD4+ The CFR was 19.9%, 24.4%, and 32.7%at 1, 3, and 7 years of age of T cell count ≤ 50 cell/μl. Related (HR = 2.14, 95% MAILA: 1.19–3.89, P<0.05) and the use of linezolid (HR = 2.97, 95% MAILA: 1.34–6.58, P<0.01) are independent prognostic factors. ART was more effective than NTM treatment for patients (HR = 0.46, 95% MAILA: 0.25–0.84, P<0.05).

In the subgroup evaluation for patients with DNTM, time was positively correlated with culture positivity with CFR (HR = 0.90, 95% MAILA: 0.84–0.96, P<0.01). The longer the time in a good culture of the specimen, the lower the number of NTMs, so survival is desirable. Old age (HR = 1.05, 95% MAILA:1.02–1.08, P<0.01), physical contact (HR= 2.38, 95% MAILA: 1.14–4.96, P<0.05) and the use of linezolid (HR = 3.39, 95% MAILA: 1.43–8.02, P<0.01) remained independent of risk factors for long -term CFR (Table 4).

Table 4 Hazard ratio in multivariate analysis of PLWH with DNTM

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