Disseminated Mycobacterium avium Complex Infection: Clinical Identification and Epidemiologic Trends

Abstract

To evaluate the incidence of disseminated Mycobacterium avium complex infection (DMAC) and to define the association between signs and symptoms and development of DMAC in patients with human immunodeficiency virus (HIV) infection, all cases ofDMAC at Grady Memorial Hospital Infectious Disease Clinic (Atlanta) between 1985 and 1990 were reviewed, and a prospective study of the association of symptoms with DMAC was done. Between 1985 and 1990, DMAC occurred in 16% of patients with AIDS. Incidence increased from 5.7% in 19851988 to 23.3% in 1989–1990 (P < .001). Median time from AIDS diagnosis to diagnosis of DMAC increased from 4.5 months in 1985–1988 to 8 months in 1989–1990 (P < .02). In the prospective study, DMAC was seen only in persons with a CD4⁺ count 3 and was associated with fever (P < .03), anemia (P < .001), weight loss (P < .01), diarrhea (P < .01), and elevated alkaline phosphatase (P < .01). It is recommended that all such HIV-infected persons have mycobacterial blood cultures done.