Disseminated M. avium complex infection in the Swiss HIV Cohort Study: declining incidence, improved prognosis and discontinuation of maintenance therapy
| Autor: | M, Rossi, M, Flepp, A, Telenti, V, Schiffer, N, Egloff, H, Bucher, P, Vernazza, E, Bernasconi, R, Weber, M, Rickenbach, H, Furrer |
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| Přispěvatelé: | Swiss HIV Cohort Study |
| Jazyk: | angličtina |
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male AIDS-Related Opportunistic Infections HIV Infections Middle Aged Mycobacterium avium Complex Prognosis Survival Analysis CD4 Lymphocyte Count Cohort Studies Withholding Treatment Antiretroviral Therapy Highly Active Humans Female AIDS-Related Opportunistic Infections/immunology AIDS-Related Opportunistic Infections/mortality AIDS-Related Opportunistic Infections/prevention & control HIV Infections/drug therapy HIV Infections/immunology HIV Infections/mortality Mycobacterium avium Complex/isolation & purification Mycobacterium avium-intracellulare Infection/immunology Mycobacterium avium-intracellulare Infection/mortality Mycobacterium avium-intracellulare Infection/prevention & control Prospective Studies Switzerland Mycobacterium avium-intracellulare Infection |
| Zdroj: | Swiss medical weekly, vol. 131, no. 31-32, pp. 471-477 |
| Popis: | Introduction of potent antiretroviral combination therapy (ART) has reduced overall morbidity and mortality amongst HIV-infected adults. Some prophylactic regimes against opportunistic infections can be discontinued in patients under successful ART. (1) The influence of the availability of ART on incidence and mortality of disseminated M. avium Complex infection (MAC). (2) The safety of discontinuation of maintenance therapy against MAC in patients on ART. The Swiss HIV-Cohort Study, a prospective multicentre study of HIV-infected adults. Patients with a nadir CD4 count below 50 cells/mm3 were considered at risk for MAC and contributed to total follow-up time for calculating the incidence. Survival analysis was performed by using Kaplan Meier and Cox proportional hazards methods. Safety of discontinuation of maintenance therapy was evaluated by review of the medical notes. 398 patients were diagnosed with MAC from 1990 to 1999. 350 had a previous CD4 count below 50 cells/mm3. A total of 3208 patients had a nadir CD4 count of less than 50 cells/mm3 during the study period and contributed to a total follow-up of 6004 person-years. The incidence over the whole study period was 5.8 events per 100 person-years. In the time period of available ART the incidence of MAC was significantly reduced (1.4 versus 8.8 events per 100 person-years, p < 0.001). Being diagnosed after 1995 was the most powerful predictor of better survival (adjusted hazard ratio for death: 0.27; p < 0.001). None of 24 patients discontinuing maintenance therapy while on ART experienced recurrence of MAC during a total follow-up of 56.6 person-years (upper 95% confidence limit 5.3 per 100 person-years). Introducing ART has markedly reduced the risk of MAC for HIV-infected individuals with a history of very low CD4 counts. Survival after diagnosis of MAC has improved after ART became available. In patients responding to ART, discontinuation of maintenance therapy against M. avium may be safe. |
| Databáze: | OpenAIRE |
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