Micobacterias no tuberculosas en personas VIH positivas y en personas sin factores de riesgo a la infección

Abstract

Immunosuppression caused by HIV infection increases the susceptibility to mycobacterial infection and disease. Due to a high prevalence of NTM in the environment, their presence in HIV infected individuals is no completely understood. To determine the clinical significance and real implications of NTM in HIV infected individuals, the prevalence of NTM in the general population compared with HIV infected individuals was analized. We studied 101 HIV positive individuals attended in Infection Service of Social Security and 100 non infected individuals. Gastric aspirates were processed for stain and culture in Ogawa Kudoh and Md 7H10 media. The prevalence of NTM in HIV positives was 7%: 2% TB and 5% NTM: 2 M. gordonae, 1 M. szulgai, 1 M. fortuitum and 1 M. avium. NTM were isolated only in cultures, in IV stage HIV infected patients, one case was associated with disease. In the control group NTM prevalence was 6%, one mycobacterial isolate non identified and 5 isolates of M. szulgai, in this group there was no association with disease. In HIV infected patients there was no correlation with pH, presence of epithelial cells, leucocytes and mucus and the presence of NTM. However NTM were more frequently isolated in HIV infected with an oral antibiotic regimen. Summarizing, in this study the prevalence of NTM was low and it was similar in control and HIV infected persons. NTM in HIV infected were associated with an advanced infection stage and the use of oral antibiotics. NTM are found in the environment and repeatedly they are colonizing in absence of clinical disease, however the clinical significance in HIV infected people must be considered depending of the immune status of patient and clinical stage of infection. Due to the frequent transient colonization by NTM, the beginning of the prophylaxis and therapy in HIV infected with NTM will be considered depending of several factors such as: source and species of mycobacterial isolates, frequency and inoculum, presence of symptoms, CD 4 lymphocytes count (< 100), the exclusion of other pathogens clinically associated and further study. © 1997 Corporación Editora Médica del Valle.