LETTRSm TO THE EDITO Absolute CD4 Count as a Predictor for Mycobacterium Avium Infection in AIDS Patients To the Editor: More is now understood about AIDS. We are seeing new diseases as well as new presentations of some older diseases. As larger numbers of HIV-infected people live longer than 2 years, we also see additional opportunistic infections. Much has been learned about preventive treatment, and the question is always raised as to when to add additional prophylactic drugs. For pneumocystic pneumonia, the absolute CD4 count of 200 or less is the gold standard. Likewise, there have been changes in azidothymidine (AZT) therapy. Patients whose CD4 counts are below 500 are treated with low doses of AZT. Mycobacterium avium infection (MAI) or the M avium complex (MAC) opportunistic organisms are caused by the Mycobacterium species. Virtually no single drug in the past has been effective against M avium, and treatment has usually been a combination of most of the antituberculous drugs, eg, isoniazid, rifampin, ethambutol, cycloserine, pyrazinamide, and streptomycin. Ciproflovacin, however, has been shown to be effective, especially as a chemoprophylactic. The pathogenesis of MAI is unclear. Many feel the bacteria is present on food, and patients are exposed to it through ingestion of food.

PURPOSE OF THE STUDY The purpose of this study was to observe the CD4 count at the time most patients were found to be

TABLE 1. CD4 COUNT OBTAINED NEAREST TO THE INITIAL DIAGNOSIS OF MYCOBACTERIUM AVIUM No. of Patients CD4 Count (N= 11) 0 500+ 0 250-500 0 150-199 0 100-149 50-99 3 8 0-49

TABLE 2. LONGITUDINAL STUDY-CD4 COUNT OF HIVPOSITIVE PATIENTS AT THE TIME MYCOBACTERIUM AVIUM WAS CULTURED CD4 Patient Count Source 1 17 Stool 2 3 4 5 6 7

1 88 42 24 32 38

positive with MAC. This was done both by looking at MAC in diagnosed patients and the CD4 count at that time, following patients who were HIV-positive and negative for MAC over a long period of time, and determining if their CD4 count changed when they became MAC positive. All patients who became positive for M avium were reviewed. The CD4 count was obtained from patients who were found to be positive for M avium by stool, sputum, or bone marrow culture. The second phase of the study entailed obtaining periodic sputum and stool cultures from patients who were HIV-positive with CD4 counts to determine the point at which they became positive for M avium. The results for both are shown in Tables 1 and 2.

Average

35

DISCUSSION As shown in Table 1, patients who developed MAI usually acquired the infection at the lower end of the spectrum of HIV infection. Mycobacterium avium infection was never the first disease encountered, and patients usually had very low CD counts-at least

Absolute CD4 count as a predictor for Mycobacterium avium infection in AIDS patients.

LETTRSm TO THE EDITO Absolute CD4 Count as a Predictor for Mycobacterium Avium Infection in AIDS Patients To the Editor: More is now understood about...
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