1685. Incidence of Disseminated Nontuberculous mycobacterium (NTM) in HIV-infected Patients; Oregon, 2007-2012
Session: Poster Abstract Session: HIV: HIV, Tuberculosis, and NTM
Saturday, October 10, 2015
Room: Poster Hall
Background:

Disseminated disease due to NTM causes significant morbidity and mortality in patients with human immunodeficiency virus (HIV). Incidence of this complication declined significantly in the late 1990s but has not been evaluated since. 

Methods:

Oregon residents with disseminated NTM (isolation from blood, CSF, bone marrow or sterile site) were identified from all NTM isolates collected 2007-2012 for statewide laboratory surveillance. We linked NTM subjects to the complete statewide HIV surveillance registry using Registry Plus™ Link Plus. Annual person-year (p-y) time began with the HIV diagnosis date or January 1 each year and patients were censored at death, NTM diagnosis or 1 year since the last CD4 or viral load result with >2 years between labs. We calculated incidence by CD4 count and year with Poisson 95% confidence intervals in SAS 9.4.

Results:

We identified 34 subjects with HIV and disseminated NTM between 2007 and 2012; most were male (26, 76.5%), non-Hispanic (27, 79.4%) and white (24, 70.6%) with a median age of 39.8 years (range 22.7-59.4). Eighteen (54.6%) were deceased with median survival of 0.3 years (range 0-5.8) after NTM diagnosis. Median CD4 count, viral load collected closest to NTM diagnosis were 14 cells/mm3 and 200,000 copies/ml (Table 1). Annual incidence ranged from 40/100,000 to 190/100,000 p-y, with the highest incidence (5760/100,000 p-y) in those with CD4 counts < 50 cells/mm3(Table 2).

 

Table 1

Characteristics of NTM Infection in Patients with HIV, 2007-2012, N=34

N (%)

Deceased

18 (54.6)

Time from HIV diagnosis to NTM diagnosis, years

3.0 (0-20.7)*

NTM species

 

     M. AUBAGNENSE

1 (2.9)

     MAC

32 (94.1)

     M. CHELONAE

1 (2.9)

CD4 Count (cells/mm3)±

14 (1-414)*

     <50

25 (75.8)

     50-100

4 (12.1)

     100-200

1 (3.0)

     >200

3 (9.1)

Viral Load copies/mL

200000 (0-4570000)*

* median (range)

± CD4 count missing in one patient

Table 2: Incidence per 100,000 p-y (95% Poisson Confidence Interval)

Year of Diagnosis

2007

2008

2009

2010

2011

2012

110

(40-250)

190

(90-340)

40

(0-130)

110

(40-230)

70

(20-180)

110

(40-230)

CD4 count closest To NTM diagnosis date (cells/mm3)

< 50

50-100

100-200

> 200

 

5760

(3730-8500)

760

(210-1940)

60

(0-310)

10

(0-40)

Conclusion:

Median yearly incidence of NTM in Oregon was 110/100,000 p-y. Most infections were due to MAC and the highest incidence was in those with a CD4 count < 50 cells/mm3.

Cara Varley, MPH1, Emily Henkle, PhD, MPH1,2, Jennifer Ku, MPH1, Sean Schafer, MD, MPH2 and Kevin L. Winthrop, MD, MPH1, (1)Oregon Health & Science University, Portland, OR, (2)STD/HIV/TB, Oregon Public Health Division, Portland, OR

Disclosures:

C. Varley, None

E. Henkle, None

J. Ku, None

S. Schafer, None

K. L. Winthrop, None

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