Association of DRB1*1501 with disseminated Mycobacterium avium complex infection in North American AIDS patients.

The HLA class II allele, DR2 (DRB1*1501), has been repeatedly found to be associated with development of tuberculosis and leprosy. We searched for associations of these and other class II alleles with disseminated Mycobacterium avium complex infection (DMAC) in North American Caucasian homosexual AIDS patients. Molecular typing for HLA-DRB1 and -DQB1 alleles in 176 cases of DMAC and 176 matched controls showed an association of accelerated onset of disease with DRB1*1501 (and the closely linked DQB1*0602) that was stronger upon adjustment for the degree and duration of CD4+ cell deficiency (P=0.04) and in multivariate analysis (P=0.02) than in unadjusted analysis. A similar trend was seen with DRB1*0701, and no other allele showed a relationship of similar magnitude. M. avium complex organisms may more effectively evade host defenses in individuals carrying an HLA polymorphism identical to that associated with M. tuberculosis and M. leprae.

[Diagnosis, therapy and prognosis of atypical mycobacterial infections--results of a retrospective study]. / Diagnostik, Therapie und Prognose atypischer Mykobakteriosen--Ergebnisse einer retrospektiven Studie.

The most important mycobacteria causing disease in humans are Mycobacterium tuberculosis and Mycobacterium leprae. These germs contrast the so-called atypical mycobacteria. The importance of the atypical mycobacteria was recognized in the fifties. Even if the quantity of atypical mycobacterial disease has increased during the last decades in Germany, it is still a rare disease today, but it is seen in patients with acquired immunodeficiency syndrome more often nowadays. In the period from 1st January 1986 til 31st December 1992 31 HIV-negative patients with a diagnosis of atypical mycobacterial disease have been seen in the department for lung diseases in the Thoraxklinik Heidelberg-Rohrbach. During the same period an atypical mycobacterial disease was diagnosed in 12 out of 413 HIV-positive patients (2.9%) of the AIDS-ambulance of the skin hospital of the University of Heidelberg. Most of the HIV-negative patients showed additional diseases which reduce the immunological resistance. In HIV-positive patients an atypical mycobacteriosis heralds a severe immunodeficiency. Because it is a rare disease and an exact diagnosis is difficult to establish there is a lack of controlled clinical trials and therefore detailed therapeutical guidelines do not exist. A therapeutical approach is also complicated by a lack of effective drugs. With disseminated disease in AIDS-patients, which is mostly caused by Mycobacterium avium-intracellulare, the therapy should be stopped, if there are any severe side-effects. The present results of therapy are still disappointing. In the future the management of atypical mycobacterial disease will be more important, because there is an increasing number of patients with acquired immunodeficiency.