the management of mycobacterium avium complex.

NLM AIDSLINE The management of Mycobacterium avium complex. Havlir DV; University of California, San Diego (UCSD), San Diego, CA.
November 30, 1996

3rd Conf Retro and Opportun Infect. 1996 Jan 28-Feb 1;:174. Unique Management of Mycobacterium avium complex (MAC) encompasses clinical decision making on prophylaxis, treatment for disseminated disease and salvage therapy. Recently completed clinical trials confirm that azithromycin and clarithromycin are superior in efficacy to rifabutin for prophylaxis reducing the incidence of MAC by approximately two thirds in HIV infected persons with less than 100 CD4+ cells. Azithromycin (1,200 mg) can be administered once weekly and resistance appears infrequently in breakthrough isolates. Gastrointestinal toxicity, but not dose limiting toxicity, is higher with azithromycin compared to rifabutin. Combination azithromycin and rifabutin is more effective than azithromycin monotherapy, but also more toxic. For the first time, a survival benefit with a MAC prophylactic strategy has been demonstrated. Clarithromycin (500 mg twice daily) reduced the incidence of MAC by 69% compared to placebo and was associated with a 31% reduction in mortality at 12 months. Clarithromycin resistant MAC was detected in 58% of prophylaxis failures, but its clinical significance remains to be determined. For treatment of newly diagnosed disseminated MAC, a clarithromycin containing regimen is superior to a four drug regimen of ethambutol, rifampin, ciprofloxacin, and clofazimine. While multiple drug regimens with clarithromycin clear bacteremia at a rate similar to clarithromycin monotherapy, the inclusion of ethambutol in a multidrug regimen reduces the incidence of relapse with resistant organisms by at least fifty percent. Widespread use of clarithromycin and azithromycin for both prophylaxis and treatment will likely reduce the overall incidence and morbidity associated with MAC. However, failures during prophylaxis and recurrences during treatment may be more difficult to treat due to resistance. Antiretroviral therapies which produce sustained increases in CD4+ counts above 100 cells/mm3 may alter the natural history of MAC. However, additional drugs with potency at least as great as the macrolides or immunomodulatory therapy may be needed to further improve the long-term outcome for this disease. Acquired Immunodeficiency Syndrome/COMPLICATIONS Azithromycin/ADMINISTRATION & DOSAGE/THERAPEUTIC USE Ciprofloxacin/ADMINISTRATION & DOSAGE/THERAPEUTIC USE Clarithromycin/ADMINISTRATION & DOSAGE/THERAPEUTIC USE Clinical Trials Clofazimine/ADMINISTRATION & DOSAGE/THERAPEUTIC USE Controlled Clinical Trials Drug Therapy, Combination Ethambutol/ADMINISTRATION & DOSAGE/THERAPEUTIC USE Human Mycobacterium avium-intracellulare Infection/COMPLICATIONS/*DRUG THERAPY Rifabutin/ADMINISTRATION & DOSAGE/THERAPEUTIC USE ABSTRACT

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Information in this article was accurate in November 30, 1996. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.