2nd National Conference Human Retroviruses and Related Infections Washington, DC - January 29 - February 2, 1995

Natl Conf Hum Retrovir Relat Infect 1995 Jan 29-Feb 2;2: (abstract no. 8)

Burman W, Rietmeijer C, Reves R
Denver Disease Control Service, Denver, CO

Clarithromycin has impressive activity, as judged by quantitative mycobacteremia, in the treatment of DMAC in AIDS. The clinical relevance of this finding is less clear.

METHODS: We reviewed records of patients with confirmed DMAC from a large AIDS clinic between 1989-93. Prior to 1992, DMAC was treated with a regimen of rifampin, ethambutol, and clofazimine. When clarithromycin was approved in 1992, it was substituted for rifampin in this regimen. We used Cox regression to explore prognostic factors in DMAC patients, including the effect of clarithromycin treatment. Transfusion-requiring was defined as receiving ≥1 unit/month or use of erythropoietin (EPO) for ≥50% of follow-up time.

RESULTS: Treatment group (n=84 in each group were well-matched for factors known to be correlated with survival of AIDS patients. Higher functional status at the time of DMAC diagnosis, anti-retroviral use, and younger age were associated with prolonged survival in a multivariate Cox regression model. A trend towards improved survival was seen in patients treated with clarithromycin vs. rifampin-based regimen (median survival of 252 vs 192 days), though this did not reach statistical significance (p=0.09). Clarithromycin-treated patients required fewer transfusions/month, 0.3 vs 1.0 (p=0.006), and were less often transfusion-dependent, 10% vs 23% (p=0.026).

CONCLUSIONS: Treatment of DMAC with a clarithromycin-based regimen was superior to a rifampin-based regimen as judged by a marked decrease in transfusional requirements. Anemia is a prominent effect of DMAC, and changes in transfusional /EPO requirements may be a valuable clinical endpoint for clinical trials of DMAC therapy.

Keywords: Acquired Immunodeficiency Syndrome, Antibiotic Prophylaxis, Case-Control Studies, Clarithromycin, Clofazimine, Drug Therapy, Combination, Ethambutol, Humans, Mycobacterium avium Complex, Mycobacterium avium-intracellulare Infection, Proportional Hazards Models, Rifampin, drug therapy, therapy

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1995-01-29
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