TREATMENT AND PROPHYLAXIS OF DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEXIN HIV-INFECTED INDIVIDUALS

OBJECTIVE: To review the pathophysiology, epidemiology, treatment, and prophylaxis of disseminated Mycobacterium avium complex (MAC) infecti on in HN-infected individuals. DATA SOURCES: A MEDLINE (January 1966-J uly 1997) and AIDSLINE (January 1980-July 1997) search of basic scienc e articles pertinent to the MAC infection in HIV-infected patients. ST UDY SELECTION AND DATA EXTRACTION: AU articles were considered for pos sible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS:The organism, ep idemiology, and pathophysiology of disseminated MAC are discussed for background. A review of clinical trials for the treatment and prophyla xis of disseminated MAC are presented, along with unresolved issues co ncerning these topics. CONCLUSIONS: The incidence of disseminated MAC has increased dramatically with the AIDS epidemic. The infection can l ead to increased morbidity and mortality in HIV-infected patients. Tre atment regimens for patients with a positive culture for MAC from a st erile site should include two or more drugs, including clarithromycin. Prophylaxis against disseminated MAC should be considered for patient s with a CD4 cell count of less than 50/mm(3).