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Disseminated Mycobacterium avium complex infections (D.MAC) in patients with the acquired immunodeficiency syndrome retrospective study of 65 patients. The Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA).
Lasseur C; Pellegrin JL; Maugein J; Morlat P; Dupon M; Leng B;
November 30, 1993
Int Conf AIDS. 1993 Jun 6-11;9(1):334 (abstract no. PO-B07-1192). Unique

D.MAC is one of the most common complications of the late stage of AIDS. We report our experience on clinical and microbiological characteristics of 65 patients. From january 1st 1986, to december 31 1992, 2490 HIV-infected patients were followed up, 737 had AIDS, 65 developed a D.MAC. There were 53 males and 12 females. Risk factors for HIV infections included homosexuality in 31 (48%), IVDU in 17 (26%), transfusion in 9 (14%), and high risk heterosexual contact in 4 (6%), unknown 4 (6%). Mean age was 37 years. D.MAC was the AIDS defining illness in 21 (32%), although 8 of the patients developed concomitant opportunistic infection. Mean delay between AIDS diagnosis and D.MAC infection was 9 months. Of the 65 patients, 58 (89%) reported fever, 47 72%) anorexia, 33 (51%) weight loss, 12 (18%) night sweats 23 35%) patients had diarrhea, 11 (17%) nausea or vomiting, 9 (14%) abdominal pain. Respiratory symptoms were observed in 42 (65%): 38 (58%) had cough, 20 (31%) expectoration and 19 (29%) dyspnea. Hepatomegaly was noted in 11 (17%) and splenomegaly in 4 (6%). Elevated alkaline phosphatase was observed in 34 (52%), hepatic cytolysis in 23 (35%) and both in 17 (26%). CD4 cells count at the time of diagnosis was less than 60/mm3 in 60 (92%) of 65 patients. The survival rate at one year was 12%. Blood cultures were positive in 53 (82%) patients. Other specimens positive for MAC included: bone marrow aspiration 9, respiratory secretions 19, digestive tract or liver biopsies 11, 24/65 had two or more sites infected. For Havlick, the incidence of D.MAC in USA increased from 5.6% in 1985-1988 period to 23.2% in 1990. In France, such a phenomena should be expected since in our cohort, the incidence of D.MAC progressively increased from 1% of AIDS cases in 1988, 4.2% in 1989, 7.4% in 1990, 9.8% in 1991 and 18% in 1992. It should justify prophylactic regimen as proposed by Gordin and Cameron (ICAAC 1992, Abst 888 and 889).

*HIV Infections/EPIDEMIOLOGY

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