Delayed CD4 cell recovery in HIV-associated disseminated nontuberculous mycobacterial disease: A case-control study

IF 4.3 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2025-09-02 DOI:10.1016/j.ijid.2025.108037

Kai Katzschner , Thomas Wichelhaus , Timo Wolf , Benjamin Marx , Iulia Dahmer , Michael Paulitsch , Annette Haberl , Gundolf Schüttfort , Pavel Khaykin , Markus Bickel , Gerrit Burger , Christoph Stephan

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Abstract

Objectives

Disseminated nontuberculous mycobacterial disease (dNTMd) remains a rare but serious complication in people living with HIV (PLWH). This study aimed to assess whether dNTMd independently contributes to delayed clusters of differentiation 4 (CD4) cell recovery after antiretroviral therapy (ART) initiation.

Methods

This retrospective 1:3 single center case-control study analyzed patient data from 2004 to 2023. PLWH and dNTMd (cases, n = 20) were matched to PLWH without evidence for mycobacterial infection (controls, n = 60) according to sex, age (±3 years), ART start date (±3 years), and baseline CD4 cell count (±100/μl). CD4 cell counts were evaluated at 10 time spans over 2 years after ART initiation using mixed median regression. Logistic regression models explored clinical and laboratory predictors of dNTMd.

Results

CD4 cell count recovery was significantly delayed in the dNTMd group (P = 0.006), although viral suppression rates were similar. Five variables were associated with dNTMd: low body mass index, high alkaline phosphatase, low hemoglobin, elevated C-reactive protein, and higher number of hospitalizations.

Conclusions

We demonstrated a link between dNTMd and significantly impaired CD4 cell count recovery in PLWH after ART initiation, independent of baseline results and viral suppression. A composite of five clinical and laboratory parameters may help identify patients at risk. Close clinical monitoring and personalized treatment approaches in PLWH with dNTMd is essential.

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hiv相关的弥散性非结核分枝杆菌病延迟CD4细胞恢复：一项病例对照研究

目的：播散性非结核分枝杆菌病（dNTMd）仍然是HIV感染者（PLWH）中一种罕见但严重的并发症。这项研究旨在评估dNTMd是否在抗逆转录病毒治疗（ART）开始后延迟cd4细胞恢复。方法：回顾性1:3单中心病例对照研究分析2004 - 2023年患者资料。根据性别、年龄（±3岁）、开始抗逆转录病毒治疗日期（±3年）和基线CD4细胞计数（±100/μl），将PLWH和dNTMd（病例，n=20）与无分枝杆菌感染证据的PLWH（对照组，n=60）进行匹配。使用混合中位数回归在抗逆转录病毒治疗开始后两年的十个时间跨度内评估CD4细胞计数。Logistic回归模型探讨了dNTMd的临床和实验室预测因素。结果：dNTMd组CD4细胞计数恢复明显延迟（p=0.006），但病毒抑制率相似。5个变量与dNTMd相关：低BMI、高碱性磷酸酶、低血红蛋白、CRP升高和住院次数增加。结论：我们证明了dNTMd与开始抗逆转录病毒治疗后PLWH cd4细胞计数恢复显著受损之间的联系，独立于基线结果和病毒抑制。五种临床和实验室参数的组合可能有助于识别有风险的患者。密切的临床监测和个性化的治疗方法是必要的PLWH与dNTMd。

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.