Immunobiology of Mycobacterium avium infection.

Infection caused by organisms of the Mycobacterium avium complex is diagnosed in 50% to 60% of AIDS patients with the advanced stage of disease. Mycobacterium avium is an environmental bacterium that gains access to the host through both the gastrointestinal tract and the respiratory tract. After crossing the mucosal barrier Mycobacterium avium disseminates, infecting chiefly mononuclear phagocytes of the reticuloendothelial system. A number of cells of the immune system such as CD4+ T cells, natural killer cells and macrophages have been shown to be involved in the host response to Mycobacterium avium. The interaction between Mycobacterium avium and macrophages results in the production of immune-suppressive cytokines that inhibit the effector function of TH1 subtype CD4+ T cells, natural killer cells and macrophages, possibly allowing survival of Mycobacterium avium. Some cytokines such as tumor necrosis factor alpha and granulocyte-macrophage colony-stimulating factor have been shown to induce mycobacteriostatic activity and mycobactericidal activity in infected macrophages. Over the next few years, much new information will certainly be gleaned about host-pathogen interactions, which will lead to a better understanding of the disease and possibly to the design of new forms of therapy.