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Ethambutol treatment duration, HIV positivity tied to 1-year improvements in NTM-PD

Tristan Manalac
08 Oct 2017

HIV positivity, the male sex and the duration of ethambutol treatment are all associated with 1-year improvements in patients with probable or definite nontuberculosis mycobacterial pulmonary disease (NTM-PD), according to a retrospective, multicentre study.

“Early predictive factors for a favourable development of … NTM-PD are important to improve management due to the high mortality of this infection at 5 years,” said researchers.

“The purpose of this study was to search for early factors that could predict at the first year the favourable or unfavourable evolution of NTM-PD,” they added.

In the study sample of 119 patients (mean age 50.4±19.4 years; 67.2 percent male) with probable or definite NTM-PD, 46 showed improvements after a year (38.6 percent; mean age 46.1±9.0 y ears; 78.2 percent male) while 73 did not (61.3 percent; mean age 55.0±20.1 years; 60.2 percent male). [PLoS Negl Trop Dis 2017;11:e0005841]

Those who improved were significantly younger (p=0.05) and were more likely to be HIV positive (36.9 vs 16.4 percent; p=0.02).

In a multivariate analysis of all patient data, the male sex was found to be significantly associated with improvements in NTM-PD status at 1 year (odds ratio [OR], 2.34; 95 percent CI, 1.26 to 8.16; p=0.02).

Other factors that were significantly correlated with improvements at 1 year were a positive HIV status (OR, 3.23; 1.27 to 8.45; p=0.01) and a longer ethambutol treatment duration (OR, 2.24; 2.11 to 3.41; p=0.001).

Notably, while the male sex was significantly associated with improvements at 1 year, no substantial gender differences in bacteriological culture findings were observed, and males showed a higher mortality at 1 year.

Indeed, previous studies have shown that “[m]en with NTM-PD have been reported as having a worse prognosis in terms of mortality than women,” explained researchers. [Am J Respir Crit Care Med 2010;181:514-521]

Previous studies have reported similar improvements in NTM-PD symptoms in persons infected with HIV. According to researchers, anti-HIV therapies likely contribute largely to this association. [Swiss Med Wkly 2001;131:471-477]

“Restoration of immunity, monitoring of these patients in specialized structures and treatment of NTM-PD have played an important role in improving prognosis,” they said.

In the subset of patients who were negative for HIV, the male sex (OR, 3.54; 1.12 to 14.0; p=0.04) and the duration of ethambutol treatment (OR, 1.90; 1.50 to 3.50; p=0.001) were significantly associated with improvements at 1 year.

Of all the participants, 57.1 percent (n=68) met the ATS/IDSA (American Thoracic Society and the Infectious Disease Society of America) criteria for NTM-PD and were thus identified as those with definite NTM-PD. In this group, the duration of ethambutol treatment was similarly associated with improvements at 1 year (OR, 2.45; 1.82 to 7.45; p=0.01).

“Identifying predictors of improvement at one year of NTM-PD is expected to optimize the management of the disease in its early stages,” researchers concluded.

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Most Read Articles
Elvira Manzano, 4 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
Yesterday
Breast cancer patients have notably different microbiomes in the local breast tissue and urinary tract, a recent study reveals. Particularly, species in the Methylobacterium genus are reduced in the local breast tissue while the urinary tract is enriched in gram-positive bacteria.
Pearl Toh, 13 Oct 2017
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.
Tristan Manalac, Yesterday
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