Mycobacterium avium complex in patients with HIV infection in the era of highly active antiretroviral therapy

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Abstract

Disseminated Mycobacterium avium complex (MAC) infection is a common complication of late-stage HIV-1 infection. Since the advent of highly active antiretroviral therapy (HAART), the rate of MAC infection has declined substantially, but patients with low CD4 cell counts remain at risk. Among patients in the Johns Hopkins cohort with advanced HIV disease, the proportion developing MAC has fallen from 16% before 1996 to 4% after 1996, with a current rate of less than 1% per year. Factors associated with developing MAC include younger age, no use of HAART, and enrolment before 1996. Prophylaxis with azithromycin or clarithromycin is recommended for all patients with CD4 counts less than 50 cells/mL. Optimum treatment for disseminated MAC includes clarithromycin and ethambutol, and another investigation suggests that the addition of rifabutin might reduce mortality. Both prophylaxis and treatment of disseminated MAC can be discontinued in patients who have responded to HAART, and specific guidelines for withdrawing treatment have been published. Although HAART has altered the frequency and outcome of MAC infection, it remains an important complication of AIDS.

Original languageEnglish (US)
Pages (from-to)557-565
Number of pages9
JournalLancet Infectious Diseases
Volume4
Issue number9
DOIs
StatePublished - Sep 1 2004

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Mycobacterium avium Complex
Highly Active Antiretroviral Therapy
HIV Infections
Clarithromycin
CD4 Lymphocyte Count
Infection
Rifabutin
Ethambutol
Azithromycin
Withholding Treatment
HIV-1
Acquired Immunodeficiency Syndrome
HIV
Guidelines
Mortality
Therapeutics

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

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title = "Mycobacterium avium complex in patients with HIV infection in the era of highly active antiretroviral therapy",
abstract = "Disseminated Mycobacterium avium complex (MAC) infection is a common complication of late-stage HIV-1 infection. Since the advent of highly active antiretroviral therapy (HAART), the rate of MAC infection has declined substantially, but patients with low CD4 cell counts remain at risk. Among patients in the Johns Hopkins cohort with advanced HIV disease, the proportion developing MAC has fallen from 16{\%} before 1996 to 4{\%} after 1996, with a current rate of less than 1{\%} per year. Factors associated with developing MAC include younger age, no use of HAART, and enrolment before 1996. Prophylaxis with azithromycin or clarithromycin is recommended for all patients with CD4 counts less than 50 cells/mL. Optimum treatment for disseminated MAC includes clarithromycin and ethambutol, and another investigation suggests that the addition of rifabutin might reduce mortality. Both prophylaxis and treatment of disseminated MAC can be discontinued in patients who have responded to HAART, and specific guidelines for withdrawing treatment have been published. Although HAART has altered the frequency and outcome of MAC infection, it remains an important complication of AIDS.",
author = "Petros Karakousis and Moore, {Richard D} and Chaisson, {Richard E}",
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