P. Kissinger et al., COMPARISON OF MULTIPLE-DRUG THERAPY REGIMENS FOR HIV-RELATED DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX DISEASE, Journal of acquired immune deficiency syndromes and human retrovirology, 9(2), 1995, pp. 133-137
In June 1993, the United States Public Health Service (USPHS) made rec
ommendations for treatment of disseminated Mycobacterium avium complex
(MAC) in patients infected with the human immunodeficiency syndrome (
HIV). It was suggested that every treatment regimen include either azi
thromycin or clarithromycin plus one or more of the following drugs: e
thambutol, clofazimine, rifabutin, rifampin, ciprofloxacin, or amikaci
n. This study compares the effect of multiple drug therapy regimens on
the survival of patients of the HIV outpatient department of the Medi
cal Center of New Orleans, Louisiana. A retrospective chart review of
122 confirmed cases of MAC was conducted. Three treatment groups were
considered: no/monotreatment (n = 40), multitreatment without clarithr
omycin (n = 32), and multitreatment with clarithromycin (n = 50). Azit
hromycin, amikacin, and rifabutin were not used in this clinic during
the study period. Both multitreatment without clarithromycin (p < 0.03
) and multitreatment with clarithromycin (p < 0.005) were significantl
y protective for survival after adjusting for CD4 cell count at time o
f diagnosis, nonadherence to treatment, number of concomitant opportun
istic infections at diagnosis, and weight loss >10%. Neither of the gr
oups that received multidrug therapy were significantly less likely to
have MAC-related symptoms than the no/mono group at 3 and 6 months po
stdiagnosis. These findings support the USPHS recommendation for multi
ple drug treatment either with or without clarithromycin. Prospective
controlled clinical trials will clarify the optimal regimen for dissem
inated MAC disease.