Impact of clarithromycin and azithromycin on patterns of treatment and survival among AIDS patients with disseminated Mycobacterium avium complex.
OBJECTIVE
To determine the impact of the introduction of clarithromycin and azithromycin on the treatment and survival of patients with AIDS and disseminated Mycobacterium avium complex (DMAC).


METHODS
Retrospective review over a 3.5-year interval.


METHODS
Tertiary-care, university teaching hospital.


METHODS
Charts of all patients with cultures of blood or bone-marrow positive for acid-fast bacilli (n = 103) were reviewed. Data on laboratory results at the time of DMAC diagnosis, antimycobacterial therapy, antiretroviral therapy, and survival was collected.


RESULTS
Prior to the availability of clarithromycin and azithromycin 61.5% of patients received antimycobacterial treatment compared with 92% afterwards (P = 0.0014). Median survival of treated patients was 255 versus 145 days for untreated patients (P < 0.001). Median survival of macrolide-treated patients was 284 versus 168 days for patients receiving treatment without a macrolide (P = 0.09). Univariate predictors of survival were antimycobacterial treatment, use of antiretrovirals, and year of diagnosis. In a multivariate model, no antimycobacterial treatment (hazard ratio, 3.83; P = 0.003) was associated with shorter survival, and treatment without a macrolide (hazard ratio, 2.29; P = 0.075) showed a trend towards shorter survival versus treatment with macrolide-containing regimens.


CONCLUSIONS
The introduction of clarithromycin and azithromycin has been associated with an increase in the proportion of patients with DMAC receiving treatment and with increased survival of these patients.
Ives
D V
DV
Division of Infectious Diseases, Beth Israel Hospital, Boston, MA 02215, USA.
Davis
R B
RB
Currier
J S
JS
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D017963:Azithromycin / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate
D017963:Azithromycin; D017291:Clarithromycin