Long-term case-fatality rate of nontuberculous mycobacterial disease in people living with HIV

Background:Few data are available regarding the long-term case-fatality rate(CFR)among people living with HIV(PLWH)with nontuberculous mycobacteria(NTM)disease.The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death.Methods:A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted from January 1,2012,to December 31,2020,in Shanghai,China.We used Kaplan-Meier survival analysis and the log-rank test to compare the long-term CFR in patients with disseminated NTM(DNTM)and localized NTM disease.Univariate Cox proportional hazards regression analysis and a stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR.Results:The cohort was followed up for a median of 26 months.The total CFR was 15.7%by one year and increased to 22.6%at 5 years after the diagnosis of NTM disease.The 5-year CFR of PLWH with DNTM was significantly higher than that of PLWH with localized NTM(26.7%vs 19.6%for DNTM and localized NTM disease,respectively).Older age[hazard ratio(HR)=1.04,95%confidence interval(CI):1.02-1.06,P<0.001],comorbidity(HR=2.05,95%CI:1.21-3.49,P<0.01),DNTM(HR=2.08,95%CI:1.17-3.68,P<0.05),and HIV viral load(HR=1.32,95%CI:1.12-1.55,P<0.001)were all independent risk factors for long-term CFR.In the subgroup analysis,time to culture positivity was negatively correlated with CFR in patients with DNTM(HR=0.90,95%CI:0.82-0.98,P<0.05).Conclusions:NTM was associated with a high long-term CFR in PLWH.Further approaches to prevent NTM disease in PLWH are urgently needed.