Delayed CD4 cell recovery in HIV-associated disseminated nontuberculous 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 clusters of differentiation 4 (CD4) cell recovery after 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 10 time spans over 2 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), although viral suppression rates were similar. Five variables were associated with dNTMd: low body mass index, high alkaline phosphatase, low hemoglobin, elevated C-reactive protein, 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.