Analysis of the differential clinical characteristics of tuberculosis and nontuberculous mycobacterial diseases among AIDS patients.

AIMS: This study aims to systematically compare the clinical characteristics of tuberculosis (TB) and nontuberculous mycobacterial (NTM) diseases in AIDS patients,and to identify independent predictors for differential diagnosis. METHODS: Clinical data of AIDS patients co-infected with TB or NTM at Shanghai Public Health Clinical Center (January 2019 - January 2024) were retrospectively analyzed. Univariate comparisons were performed using t-test, Mann-Whitney U test, χ2 or Fisher's exact test, with Bonferroni correction for multiple comparisons. Multivariate binary logistic regression (Enter method) was used to adjust for age, gender, CD4+ T-cell count, C-reactive protein (CRP), procalcitonin, neutrophil count, miliary nodules, and superficial lymphadenopathy. RESULTS: A total of 494 patients were included (AIDS/TB: 206, AIDS/NTM: 288). The predominant NTM species was Mycobacterium avium (68.2%), followed by Mycobacterium kansasii (13.6%) and Mycobacterium intracellulare (10.9%). After Bonferroni correction, AIDS/NTM patients had significantly higher rates of Pneumocystis jirovecii pneumonia, cytomegalovirus infection, and progressive multifocal leukoencephalopathy (all P < 0.0083). Among clinical symptoms, only enlarged lymph nodes remained significantly more common in the TB group after correction (P = 0.002). Multivariate analysis showed that male gender (adjusted OR for NTM vs. TB = 0.451, 95% CI: 0.208-0.979, P = 0.044), higher CD4+ count (per 10 cells/μL: OR = 0.98, 95% CI: 0.96-0.99, P = 0.005), higher CRP (per 10 mg/L: OR = 0.90, 95% CI: 0.86-0.95, P < 0.001), higher neutrophil count (OR = 0.903 per 1 × 10(Akokuebere et al., 20249)/L, 95% CI: 0.836-0.976, P = 0.010), presence of miliary nodules (OR = 0.079, 95% CI: 0.027-0.233, P < 0.001), and presence of superficial lymphadenopathy (OR = 0.565, 95% CI: 0.327-0.977, P = 0.041) were independently associated with lower odds of NTM disease (i.e., associated with TB). Imaging revealed that only miliary nodules remained significantly more common in TB after Bonferroni correction (P < 0.001). CONCLUSIONS: While AIDS/TB and AIDS/NTM share many clinical similarities, the presence of miliary nodules, superficial lymphadenopathy, higher inflammatory markers (CRP, neutrophils), higher CD4+ count, and male gender favor TB. These findings can assist clinicians in differentiating the two infections when rapid microbiological results are unavailable. The high prevalence of Mycobacterium avium (68.2%) suggests that empirical therapy for suspected NTM in severely immunocompromised AIDS patients in Shanghai should cover the Mycobacterium avium complex (MAC). Prospective multicenter studies with pre-specified outcomes are needed to validate our findings.