Treatment and prophylaxis of disseminated Mycobacterium avium complex in HIV-infected individuals.
OBJECTIVE
To review the pathophysiology, epidemiology, treatment, and prophylaxis of disseminated Mycobacterium avium complex (MAC) infection in HIV-infected individuals.


METHODS
A MEDLINE (January 1966-July 1997) and AIDSLINE (January 1980-July 1997) search of basic science articles pertinent to the MAC infection in HIV-infected patients.


METHODS
All articles were considered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion.


RESULTS
The organism, epidemiology, and pathophysiology of disseminated MAC are discussed for background. A review of clinical trials for the treatment and prophylaxis of disseminated MAC are presented, along with unresolved issues concerning these topics.


CONCLUSIONS
The incidence of disseminated MAC has increased dramatically with the AIDS epidemic. The infection can lead to increased morbidity and mortality in HIV-infected patients. Treatment regimens for patients with a positive culture for MAC from a sterile site should include two or more drugs, including clarithromycin. Prophylaxis against disseminated MAC should be considered for patients with a CD4 cell count of less than 50/mm3.
Faris
M A
MA
Clinical Research Scientist, Respiratory Clinical Research, Glaxo Wellcome, Inc., Research Triangle Park, NC, USA.
Raasch
R H
RH
Hopfer
R L
RL
Butts
J D
JD
D042462:4-Quinolones; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002991:Clofazimine / Q000627:therapeutic use; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D018942:Macrolides; D015269:Mycobacterium avium Complex / Q000187:drug effects*; D015270:Mycobacterium avium-intracellulare Infection / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D012294:Rifamycins / Q000627:therapeutic use
D042462:4-Quinolones; D000900:Anti-Bacterial Agents; D018942:Macrolides; D012294:Rifamycins; D004977:Ethambutol; D002991:Clofazimine; C009186:rifamide