Delayed CD4 cell recovery in HIV-associated disseminated non-tuberculous 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 CD4-cell recovery following 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 ten timespans over two 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), though viral suppression rates were similar. Five variables were associated with dNTMd: low BMI, high alkaline phosphatase, low hemoglobin, elevated CRP, 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.