Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

MYCOBACTERIUM AVIUM COMPLEX PROPHYLAXIS AND TREATMENT

Richard E. Chaisson
Johns Hopkins University, Baltimore, MD, USA

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. 6.1
AIDS 1996, Vol. 10 (Suppl. 2);S4

Disseminated and localized M. avium complex (MAC) infections continue to be important complications of advanced HIV disease. The risk of developing MAC begins to rise as CD4 cell counts fall below 100, and prophylaxis is recommended for patients with counts <75. In the past year, three major developments have occurred. First, prophylaxis of MAC has been shown to prolong survival. Second, both clarithromycin and azithromycin have been found to have superior efficacy to rifabutin in preventing MAC. Third, prophylaxis with the macrolides results in macrolide-resistant organisms in 11 to 59 percent of failures. Selection of a drug for MAC prophylaxis is influenced by efficacy, adverse reactions, drug interactions, emergence of resistance and cost.

Treatment of disseminated MAC has made substantial progress in the past year. Several studies have shown that clofazimine has little antimicrobial activity, and may be harmful. Combination therapy with clarithromycin, ethambutol, and rifabutin is highly active and prolongs survival. This regimen is likely to be active against clarithromycin-resistant MAC. Life-long suppressive therapy is mandatory. Alternative agents for management of relapses are urgently needed. The prospect of immunotherapy for MAC remains alluring but unrealized. Continued progress in the management of MAC will likely emerge from ongoing investigations.

Presenting author: Richard E. Chaisson

1996-11-03
6.1

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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