title: [Disseminated infection with Mycobacterium avium complex (MAC) in HIV infection].
abstract: BACKGROUND
  Disseminated MAC-infection is one of the most frequent opportunistic infections occurring in HIV-infected patients. Severely immunocompromised patients with CD4-counts < 50/microliter are at greatest risk for the disease. Survival of untreated infection is very poor (5 to 6 months). With therapy survival is prolonged by about 4 months. CLINICAL PRESENTATION AND DIAGNOSTIC PROCEDURES: The leading symptom of MAC-infection is fever eventually accompanied by weight lost, night sweats, enlarged lymph nodes, hepatosplenomegaly, abdominal pain and anemia. Blood cultures are very sensitive and the most appropriate examination. Other diagnostic procedures include bone marrow cultures, biopsies of the gastrointestinal tract, lymph nodes and the liver. Detection of MAC in sputum and stool samples only proves colonisation but not dissemination. However, colonisation of the gastrointestinal tract frequently precedes disseminated disease.
  
  
  METHODS
  Combination of clarithromycin, rifabutin and ethambutol has proven to be the most efficacious therapy and therefore has to be considered as standard therapy for disseminted MAC-infection. Problems most frequently encountered with this medication include uveitis (rifabutin) gastrointestinal disturbances (clarithromycin) and leucopenia (rifabutin) as well as drug interactions with protease-inhibitors (rifabutin).
  
  
  RESULTS
  Clarithromycin, rifabutin and azithromycin given as primary prophylaxis can diminish the risk of disseminated MAC-infection. Although a survival benefit has been seen with clarithromycin, primary prophylaxis of MAC-infection is not standard care in many centers. Reasons to withhold MAC-prophylaxis include lower incidence rates in some countries as well as possible side effects and drug interactions.
  
  
  CONCLUSIONS
  Disseminated MAC-infection is a frequent opportunistic disease in HIV-infected persons who are severely immunocompromised. Antibiotic combination therapy with clarithromycin, rifabutin and ethambutol improves clinical symptoms and survival. Primary prophylaxis with different regimens is efficacious but the specific epidemiologic situation in each country has to be considered.
authors.affiliation: Klinik I für Innere Medizin, Universität Köln.
authors.forename: G
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: B
authors.initials: B
authors.lastname: Salzberger
authors.forename: V
authors.initials: V
authors.lastname: Diehl
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000995:Antitubercular Agents
vernacular_title: Die disseminierte Infektion mit Mycobacterium avium complex (MAC) bei HIV-Infektion.