Other non-tuberculous mycobacteria

The frequency of other NTM infections in people with HIV infection is lower than infections with MAC. In one retrospective series from Germany over 10 years (2006-2016), there were 87 patients with HIV infection out of a total of 297 (29%) patients with NTM infection.36 Thirty eight per cent of the people with HIV infection had disseminated mycobacterial infection and 50% had pulmonary disease or colonisation. MAC was the most common organism (56%) with M. xenopi, M. kansasii, M. fortuitum being the next most common, representing 16 (18%), 5 (6%) and 4 (5%) cases, respectively. A similar frequency distribution was found in a study from Shanghai, China, where MAC was the most common NTM isolated from people with HIV infection (42% of isolates), followed by M. gordonae (28%) and M. kansasii (25%).37 Another study from Guangxi, China confirmed a similar distribution in sputum samples, where 54% were MAC, 9% were M. gordonae and 8% were M. kansasii.38 Other NTM species may also infect people with HIV infection.

Infections by NTM other than MAC may present as disseminated disease, pulmonary disease, lymphadenitis, arthritis, vertebral osteomyelitis, pleural and pericardial disease and other manifestations.39 As described for MAC, other NTM may colonise the respiratory tract as well as cause invasive pulmonary disease. Severe CD4+ T cell deficiency is also a risk factor for invasive disease.40

Due to the relative rarity of infection with other NTM, the evidence base for treatment of non-MAC NTM disease in HIV infection is limited to case reports and is generally conducted in line with the treatment of NTM infections in the HIV-uninfected population. Clinicians should check for drug-drug interactions before prescribing therapy for NTM infection in people treated for HIV infection. An IRIS syndrome has been reported with non-MAC NTM infections.41-44