Trends in nontuberculous mycobacterial disease in hospitalized subjects in Spain (1997–2010) according to HIV infection

Publisher: John Wiley & Sons Inc

E-ISSN: 1468-1293|16|8|485-493

ISSN: 1464-2662

Source: HIV MEDICINE, Vol.16, Iss.8, 2015-09, pp. : 485-493

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Abstract

ObjectivesThe aim of the study was to estimate the incidence of nontuberculous mycobacterial (NTM) disease and the rate of NTM disease‐related mortality and to analyse trends in these variables according to HIV infection.MethodsWe performed a retrospective study for the period 1997–2010 using data from the Minimum Basic Data Set (MBDS) provided by the Spanish Ministry of Health. The exposure variables were: (i) HIV infection (HIV positive versus HIV negative); (ii) calendar period in relation to widespread use of combination antiretroviral therapy (cART) [1997–1999 (early cART period), 2000–2003 (middle cART period) and 2004–2010 (late cART period)]. The outcome variables were (i) new NTM disease diagnosis and (ii) mortality.ResultsA total of 3729 cases of incident NTM disease were collected in MBDS, 1795 in the HIV‐negative group and 1934 in the HIV‐positive group, among whom 602 deaths occurred, 223 in the HIV‐negative group and 379 in the HIV‐positive group. The incidence of NTM disease and the rate of NTM disease‐related mortality were 1000‐fold higher in the HIV‐positive group than in the HIV‐negative group. Regarding the incidence of NTM disease, in the HIV‐negative group the incidence increased from 2.91 to 3.97 events per 1 000 000 patient‐years from 1997–1999 to 2004–2010 (P < 0.001), while in the HIV‐positive group the incidence decreased from 2.29 to 0.71 events per 1000 patient‐years from 1997–1999 to 2004–2010 (P < 0.001). Regarding mortality, in the HIV‐negative group mortality increased from 2.63 to 4.26 events per 10 000 000 patient‐years from 1997–1999 to 2000–2003 (P = 0.059), and then the rate stabilized at around 3.87 events per 10 000 000 patient‐years in 2004–2010 (P = 0.128), while in the HIV‐positive group mortality decreased from 4.28 to 1.39 events per 10 000 patient‐years from 1997–1999 to 2004–2010 (P < 0.001).ConclusionsHIV infection was associated with a higher NTM disease incidence and higher NTM disease‐related mortality than in the general population, but these rates decreased in the HIV‐positive group from 1997–1999 to 2004–2010, whereas the NTM disease incidence increased in the HIV‐negative group.

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