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AIDS Therapies: As Cell Count Increases, Treatment for Mycobacterium avium Not Needed






 

- New study indicate that when HIV+ patients' CD4+ cell counts increase to 100 cells/mm3 or more, azithromycin, which is a drug used to prevent and treat Mycobacterium avium complex disease, can be discontinued.

These findings were reported by researchers in the New England Journal of Medicine.

M. avium complex (MAC) disease is an opportunistic disease sometimes seen in HIV infected patients whose CD4+ cell counts are extremely low. Until now, investigators have been uncertain as to whether prophylactic treatment should be stopped when CD4+ cell counts improve, according to W.M. Elsadr and others at New York's Harlem Hospital Center.

Over 200 patients infected with HIV were enrolled in a trial comparing azithromycin-treated patients with untreated patients. At trial initiation, the median CD4+ cell count was 200 cells/mm3. However, the median CD4+ cell counts in these patients after completing antiretroviral therapy had been as low as 23 cells/mm3. In addition, "65% of the patients had had an acquired immune deficiency syndrome-defining illness," Elsadr et al. reported.

Study findings showed that none of the patients acquired a case of MAC disease during the 12 months following study initiation.

Somewhat more than 1% of the treated patients and a slightly higher percentage of untreated patients developed bacterial pneumonia in this study.

Data also indicated that mortality and disease progression for HIV infection were relatively the same in both the treated and untreated groups.

More of the azithromycin patients discontinued treatment due to adverse effects (n=19) than did the non-treated patients (n=3), study findings showed.

Elsadr et al. concluded, "Azithromycin prophylaxis can safely be withheld in HIV infected patients whose CD+ cell counts have increased to more than 100 cells/mm3 in response to antiretroviral therapy" ("Discontinuation of prophylaxis against Mycobacterium avium complex disease in HIV infected patients who have a response to antiretroviral therapy," N Engl J Med 2000 Apr 13;342(15):1085-92.

For more information about this study, contact W.M. Elsadr, Harlem Hospital Center, Division of Infectious Diseases, 506 Lenox Avenue, Room 3107, New York, New York 10037, USA.

Key points reported in this study are:

  • Mycobacterium avium complex disease (MAC) is an opportunistic disease sometimes acquired by HIV infected patients with low CD4+ cell counts

  • Prophylactic therapies are often prescribed to patients with HIV in order to prevent MAC, with no clear indicators as to when to discontinue therapy

  • Patients with HIV who have been treated with antiretroviral therapies can discontinue prophylactic azithromycin therapy when their CD4+ cell counts become greater than or equal to 100 cells/mm3

This article was prepared by AIDS Weekly editors from staff and other reports.



 


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Information in this article was accurate in May 29, 2000. 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.