Am. J. Respir. Crit. Care Med., Volume 162, Number 3, September 2000, 865-872

Infections with Mycobacterium tuberculosis and Mycobacterium avium among HIV-infected Patients after the Introduction of Highly Active Antiretroviral Therapy

OLE KIRK, JOSE M. GATELL, AMANDA MOCROFT, COURT PEDERSEN, RUI PROENCA, RAY P. BRETTLE, SIMON E. BARTON, PHILIPPE SUDRE, ANDREW N. PHILLIPS, and JENS D. LUNDGREN, for the EuroSIDA Study Group

EuroSIDA Coordinating Centre, Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark; Servicio Infecciones, Hospital Clinic i Provincial, Barcelona, Spain; Royal Free Centre of HIV Medicine and Department of Primary Care and Population Sciences, Royal Free Hospital, London, United Kingdom; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Servicio de Medicine e Doencas Infecciosas, Hospital Curry Cabral, Lisbon, Portugal; Regional Infectious Disease Unit, Western General Hospital, Edinburgh, Scotland; St. Stephen's Clinic, Chelsea & Westminster Hospital, London, United Kingdom; and Swiss HIV Cohort Study, Data and Co-ordination Centre, University Hospital, Lausanne, Switzerland

The impact of highly active antiretroviral therapy (HAART) among human immunodeficiency virus (HIV)-infected patients on the incidences of mycobacterial infections has not been studied in detail. We assessed incidences of mycobacterial diseases among HIV- infected patients following the introduction of HAART, using data from the EuroSIDA study, a European, multicenter observational cohort of more than 7,000 patients. Overall incidences of Mycobacterium tuberculosis (TB) and Mycobacterium avium complex (MAC) were 0.8 and 1.4 cases/100 person-years of follow-up (PYF), decreasing from 1.8 (TB) and 3.5 cases/100 PYF (MAC) before September 1995 to 0.3 and 0.2 cases/100 PYF after March 1997. After adjustment for changes in CD4 cell count and use of antiretroviral treatment in Cox proportional hazards models, the risk of MAC decreased with increasing calendar time (hazard ratio per calendar year; HR = 0.58 [95% confidence intervals: 0.45-0.74], whereas this was not the case for TB; 0.95 [0.74-1.22]). In conclusion, we documented marked decreases in the incidence of TB and to an even larger extent of MAC among HIV-infected patients from 1994 to 1999. The decrease in TB was associated with the introduction of HAART and changes in CD4 cell count. These factors could also explain some of the decrease in MAC over time, though there remained a significantly lower risk of MAC than expected.

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