Am. J. Respir. Crit. Care Med., Volume 160, Number 1, July 1999, 10-14

The Impact of HIV Infection on Mycobacterium kansasii Disease in South African Gold Miners

ELIZABETH L. CORBETT, GAVIN J. CHURCHYARD, MALCOLM HAY, PHILIP HERSELMAN, TIM CLAYTON, BRIAN WILLIAMS, RICHARD HAYES, DAAN MULDER, and KEVIN M. DE COCK

Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Departments of Medicine, Radiology, and Occupational Health, Ernest Oppenheimer Hospital, Welkom, South Africa; Epidemiology Research Unit, Johannesburg, South Africa; and Tropical Epidemiology and Public Health, Institute of Social Medicine, University of Amsterdam, Amsterdam, The Netherlands

The impact of human immunodeficiency virus (HIV) infection on Mycobacterium kansasii disease in miners was investigated with a retrospective study covering a single workforce. M. kansasii, isolated from 43 HIV-positive and 202 HIV-negative miners, was the most common nontuberculous mycobacterial (NTM) species in both HIV groups. CD4 counts were unusually high for M. kansasii disease (mean 490 × 10⁶/L, from 14 HIV-positive men). Treatment outcomes were similar: mortality during treatment was higher in HIV-positive than in HIV-negative men (9% and 2%, respectively), but not significantly so. The majority of a sample of 31 HIV-positive and 92 HIV-negative men had radiological silicosis and/or old tuberculosis scarring prior to M. kansasii disease. A normal premorbid radiograph was more common in HIV-positive men (45% versus 24%; odds ratio [OR], 2.62; 95% confidence interval [95% CI], 1.01 to 6.67). New cavitation was less common (55% versus 78%; OR, 0.34; 95% CI, 0.13 to 0.88) and new hilar adenopathy more common (OR, 5.07; 95% CI, 1.24 to 21.9) in HIV-positive than in HIV-negative men. Miners, who have additional NTM risk factors, develop M. kansasii disease that occurs at an earlier stage of HIV infection and more closely resembles disease in HIV-negative men than has been found for HIV-associated M. kansasii disease in other settings.

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