A RETROSPECTIVE COMPARISON OF CLARITHROMYCIN VERSUS RIFAMPIN IN COMBINATION TREATMENT FOR DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX DISEASE IN AIDS - CLARITHROMYCIN DECREASES TRANSFUSION REQUIREMENTS

SETTING: Urban county medical center. OBJECTIVE: To compare clinical o utcomes associated with two treatment regimens for AIDS-associated dis seminated Mycobacterium avium complex (DMAC). From 1989 to mid-1992, p atients were treated with rifampin, ethambutol, and clofazimine; in mi d-1992 clarithromycin replaced rifampin. DESIGN: A retrospective revie w of patients with DMAC; the main outcome measures assessed were toxic ity associated with DMAC treatment, transfusions after the diagnosis o f DMAC, and survival. RESULTS: 88 patients received the rifampin-based regimen and 86 were treated with the clarithromycin-based regimen. Dr ug-related adverse events were recorded less frequently with clarithro mycin treatment (21% vs. 42%, P = 0.005), and additional antimycobacte rial agents were used less often (28% vs. 44%, P = 0.04). In a multiva riate logistic regression model, severe anemia at the time of DMAC dia gnosis was associated with transfusion-dependence (relative risk [RR] 5.6, 95% confidence interval [CI] 2.2, 13.8, P< 0.001) and clarithromy cin treatment was inversely associated with transfusion dependence (RR 0.4, 95% CI 0.1, 0.98, P = 0.04). In a multivariate Cox regression mo del including other factors affecting survival, clarithromycin treatme nt did not confer a survival advantage (P = 0.74). CONCLUSIONS: The cl arithromycin-containing regimen was better tolerated and was associate d with substantially lower transfusion requirements than the rifampin- based regimen; survival was not affected.