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

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.