| BackgroundThe latest report released by the World Health Organization shows that by the end of 2021,there were approximately 38.4 million people living with human immunodeficiency virus(HIV)worldwide.Despite effective antiretroviral therapy(ART)and active prevention and treatment of opportunistic infections associated with acquired immune deficiency syndrome(AIDS),650,000 people died from AIDS-related illnesses in 2021.Non-tuberculous mycobacteria(NTM)infection is one of the major opportunistic infections in patients with AIDS.Patients with disseminated NTM disease(DNTM)are generally critically ill with a high case-fatality rate(CFR).However,international studies on the prognostic evaluation of AIDS patients with NTM are limited.Therefore,it is necessary to conduct this study to analyze the clinical characteristics of AIDS patients with NTM and to analyze the risk factors affecting their prognosis,so that targeted interventions can be proposed to extend the life expectancy of patients and improve their quality of survival.ObjectiveTo analyze the clinical characteristics,survival status,CFR,and prognostic risk factors of AIDS patients with NTM.MethodsA retrospective cohort study of 379 cases of pathogenically confirmed NTM disease in AIDS patients with NTM were conducted from January 1,2012,to December31,2020,in Shanghai,China.Kaplan-Meier survival analysis and log-rank test were used to compare the CFR in patients with DNTM and localized NTM disease.Multivariate Cox proportional hazards stepwise regression model was used to estimate the prognostic risk factors.The life table method was used to estimate the CFR and assess the survival status in the population.Results1.Clinical characteristics Three hundred seventy-nine patients were included.Of these,93.67%were male,and the median age was 38.00(IQR:30.00-50.00)years.One hundred thirteen patients(29.81%)had comorbidities,and 136 patients(35.88%)had opportunistic infections.In addition,the median CD4~+T cell count was 23.00(IQR:6.00-73.75)cells/μL,and the median HIV viral load was 4.84(IQR:1.92-5.45)log10 copies/ml.Two hundred ninety-four patients(77.57%)received ART prior to anti-NTM therapy,and the median time from initiation of ART to initiation of anti-NTM therapy was 31.00(IQR:4.00-127.00)months.The most common symptoms in all patients was fever(63.44%),followed by cough(44.09%),wasting(21.77%)and abdominal pain and/or diarrhea(18.28%).12.90%reported central nervous system symptoms such as headache and/or dizziness,of which more than one third(39.58%,19/48)of them had a combination of cryptococcal meningitis.The remaining 11.56%of patients had skin manifestations,such as rashes.The most common patternmorphology on chest CT of the chest was mediastinal lymph node enlargement.2.Survival analysis After a median of 26 months of follow-up,69 patients(18.21%)died,and 48(12.66%)were lost to follow-up.In 52.24%of patients,the follow-up period exceeded 2 years.Life table method showed that the CFR of the total population were 15.66%,19.99%and 22.60%at 1,3 and 5 years,respectively.The 3-year CFR of AIDS patients with DNTM was significantly higher than that of patients with localized NTM(26.33%vs.14.93%).Older age[hazard ratios(HR)=1.04,95%confidence intervals(CIs):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 CFR.In the subgroup analysis,the 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 CFR in AIDS patients,and AIDS patients with a history of NTM may require closer long-term follow-up.Further approaches to prevent NTM disease in AIDS patients are urgently needed. |
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