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Mycobacterium genavense Infection and Survival

Mycobacterium genavense Infection and Survival Abstract We read with interest the article by Pechère and colleagues1 on Mycobacterium genavense infection in patients with human immunodeficiency virus infection. Based on a comparison of survival with CD4 cell count—matched controls, the authors concluded that M genavense infection lessens survival. Clearly, there are biological reasons to believe that this disease could lessen survival. However, we suggest caution in attributing causality to M genavense infection and its treatment in the interpretation of the statistical relationships of these observational data. An alternative explanation for the association of M genavense infection with decreased survival is that the mycobacterial infection is a marker of more severe immunosuppression that is not accounted for by CD4 cell count alone. Although controls were matched on CD4 cell count, this measure may be an incomplete marker of degree of immunosuppression in Pechère and colleagues' study as it is in other settings.2,3 Data from the Multicenter References 1. Pechère M, Opravil M, Wald A, et al. Clinical and epidemiologic features of infection with Mycobacterium genavense. Arch Intern Med . 1995;155:400-404.Crossref 2. De Gruttola V, Wulfsohn M, Fischl MA, Tsiatis A. Modeling the relationship between survival and CD4 lymphocytes in patients with AIDS and AIDS-related complex. J Acquir Immune Defic Syndr . 1993;6:359-365. 3. Choi S, Lagakos SW, Schooley RT, Volberding PA. CD4+ lymphocytes are an incomplete surrogate marker for clinical progression in persons with asymptomatic HIV infection taking zidovudine. Ann Intern Med . 1993;118:674-680.Crossref 4. Hoover DR, Black C, Jacobson LP, et al. Epidemiologic analysis of Kaposi's sarcoma as an early and later AIDS outcome in homosexual men. Am J Epidemiol . 1993;138:266-278. 5. Breslow NE, Day NE. Statistical Methods in Cancer Research:The Design and Analysis of Cohort Studies . Lyons, France: International Agency for Research on Cancer; 1987;2. 6. Hoover DR. The effects of long term zidovudine therapy and Pneumocystis carinii prophylaxis on HIV disease: a review of the literature. Drugs . 1995; 49:20-36.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Mycobacterium genavense Infection and Survival

Mycobacterium genavense Infection and Survival

Abstract

Abstract We read with interest the article by Pechère and colleagues1 on Mycobacterium genavense infection in patients with human immunodeficiency virus infection. Based on a comparison of survival with CD4 cell count—matched controls, the authors concluded that M genavense infection lessens survival. Clearly, there are biological reasons to believe that this disease could lessen survival. However, we suggest caution in attributing causality to M genavense infection and its...
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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430190124019
Publisher site
See Article on Publisher Site

Abstract

Abstract We read with interest the article by Pechère and colleagues1 on Mycobacterium genavense infection in patients with human immunodeficiency virus infection. Based on a comparison of survival with CD4 cell count—matched controls, the authors concluded that M genavense infection lessens survival. Clearly, there are biological reasons to believe that this disease could lessen survival. However, we suggest caution in attributing causality to M genavense infection and its treatment in the interpretation of the statistical relationships of these observational data. An alternative explanation for the association of M genavense infection with decreased survival is that the mycobacterial infection is a marker of more severe immunosuppression that is not accounted for by CD4 cell count alone. Although controls were matched on CD4 cell count, this measure may be an incomplete marker of degree of immunosuppression in Pechère and colleagues' study as it is in other settings.2,3 Data from the Multicenter References 1. Pechère M, Opravil M, Wald A, et al. Clinical and epidemiologic features of infection with Mycobacterium genavense. Arch Intern Med . 1995;155:400-404.Crossref 2. De Gruttola V, Wulfsohn M, Fischl MA, Tsiatis A. Modeling the relationship between survival and CD4 lymphocytes in patients with AIDS and AIDS-related complex. J Acquir Immune Defic Syndr . 1993;6:359-365. 3. Choi S, Lagakos SW, Schooley RT, Volberding PA. CD4+ lymphocytes are an incomplete surrogate marker for clinical progression in persons with asymptomatic HIV infection taking zidovudine. Ann Intern Med . 1993;118:674-680.Crossref 4. Hoover DR, Black C, Jacobson LP, et al. Epidemiologic analysis of Kaposi's sarcoma as an early and later AIDS outcome in homosexual men. Am J Epidemiol . 1993;138:266-278. 5. Breslow NE, Day NE. Statistical Methods in Cancer Research:The Design and Analysis of Cohort Studies . Lyons, France: International Agency for Research on Cancer; 1987;2. 6. Hoover DR. The effects of long term zidovudine therapy and Pneumocystis carinii prophylaxis on HIV disease: a review of the literature. Drugs . 1995; 49:20-36.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 23, 1995

References