Mycobacterium avium infection and immune restoration disease after highly active antiretroviral therapy in a patient with HIV and normal CD4+ counts.

A patient infected with HIV who had normal CD4+ T-cell counts developed Mycobacterium avium complex lymphadenitis associated with restoration of delayed-type hypersensitivity responses to mycobacterial antigens after commencing highly active antiretroviral therapy (Mycobacterium avium immune restoration disease). This case provides further evidence that delayed-type hypersensitivity responses and CD4+ T-cell counts are independent indicators of the cellular immune defects induced by HIV infection and that Mycobacterium avium immune restoration disease may occur in patients with persistently normal CD4+ T-cell counts.