Atypical mycobacterial infection, especially with Mycobacterium avium complex (MAC), is one of the leading causes of mortality in HIV-infected children.

Objective: To compare the clinical outcome and the survival time of two groups of HIV-infected children with atypical mycobacterial infection followed at Children's Hospital of New Jersey AIDS Program, Newark, New Jersey. Group I(n=20) includes patients between January 81 to December 91 and did not receive antimycobacterial therapy with an exception for 2 patients, group II(n=24) includes patients seen between January 92 and December 95 and 19 of them have received treatment.

Methods: Laboratory and medical records of HIV-infected children with atypical mycobacterial infection were reviewed. Clinical signs and symptoms, CD4+lymphocyte count and treatment modalities were recorded.

Results: Median age for Group I was 54 months (11-141 months) and 89 months(6 to 202 months) for group II. Ninety percent from both groups met the criteria for AIDS before detection of positive culture for atypical mycobacteria. Median CD4+ lymphocyte count was respectively 29 cells/mm3 for group I and 23 cells/mm3 for group II. Persistent failure to gain weight, recurrent fever and abdominal pain were the major symptoms reported by both groups. Seventy percent from group I and 96% from group II have received antiretroviral therapy. Disseminated disease was present in 12 patients from group I and 17 from group II. All isolates but two from group I were identified as MAC. The other two isolates were identified as M. kansaii and M. scrofulaceum. The median survival time was 4 months for the untreated group and 15 months for the group who has received treatment.

Conclusion: Treatment with antimycobacterial agents appears to prolong survival in children with atypical mycobacterial infection and advanced HIV disease.