Clinical outcome of HIV/AIDS patients with Mycobacterium spp. disease associated with Cytomegalovirus viremia: a retrospective study.

Background: The mycobacterial and cytomegalovirus co-infection represents a critical intersection of infectious challenges, especially in the context of people living with human immunodeficiency virus infection. This relation raises questions on whether this co-infection represents increased mortality risk. Elucidating the critical interplay between these two microorganisms is imperative to promptly assess and intervene in the patient’s clinical evolution. The primary endpoint of the present study was to compare the 90-day mortality of immunocompromised people living with HIV/AIDS co-infected with tuberculous and non-tuberculous mycobacteria with and without cytomegalovirus infection. Methods: We conducted a comparative, observational, retrospective study in a tertiary care setting in Mexico City that provides clinical care for people living with HIV. Sociodemographic, clinical, and biochemical data was collected to assess disease evolution, as well as a 90-day retrospective follow-up to evaluate mortality. Statistical analysis was performed to evaluate sample heterogeneity. A survival analysis and Cox proportional hazards analysis were performed to specifically elucidate the effect on mortality of people who presented co-infection of active mycobacterial disease with or without Cytomegalovirus. Results: Mortality between groups failed to demonstrate statistical significance (HR: 1.773, 95%CI: 0.8163, 3.852; p = 0.1479). Aside from the survival analysis, overall mortality at 90-day follow-up was 13%, which is similar to worldwide mortality reported by the World Health Organization (12%). Severe sepsis ( p = 0.032) and multiple organ failure ( p = 0.016) predicted mortality, while immune failure ( p = 0.001) and a positive cytomegalovirus viremia ( p = 0.023) increased risk for disease relapse. Higher body mass index was protective against mortality ( p = 0.042). Conclusions: This study of cytomegalovirus and mycobacterial co-infections in Mexican people living with HIV found no significant mortality or outcome differences by cytomegalovirus viremic status, potentially reflecting effective standard of care. While limited by sample size, the robust model discrimination suggests Cytomegalovirus co-infection may not independently worsen outcomes in well-managed populations. These findings highlight the importance of maintaining optimal antiretroviral therapy and mycobacterial treatment coverage in resource-appropriate settings.