title: Prevention and treatment of disseminated Mycobacterium avium complex infection in human immunodeficiency virus-infected individuals.
abstract: Disseminated Mycobacterium avium complex (DMAC) infection is a common complication of advanced HIV disease, and is an independent predictor of mortality. The clinical features of DMAC infection are fever, weight loss, abdominal pain, anemia, elevated serum alkaline phosphatase, and elevated serum lactate dehydrogenase. The diagnosis is made by blood cultures; clinical diagnosis is unreliable. Chemoprophylaxis of DMAC infection with azithromycin is recommended when the CD4 lymphocyte count is below 50 cells/mm3. Established DMAC infection is treated with clarithromycin plus ethambutol, unless the isolate is macrolide-resistant, in which case the optimal therapy is uncertain. Highly active antiretroviral therapy is important in both prevention and treatment of DMAC infection.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alberta, Walter C. Mackenzie Health Science Centre, Edmonton, Alberta, Canada.
authors.forename: S D
authors.initials: SD
authors.lastname: Shafran
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D017291:Clarithromycin / Q000627:therapeutic use; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D018655:Lymphocyte Count; D015269:Mycobacterium avium Complex / Q000187:drug effects / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D017963:Azithromycin; D004977:Ethambutol; D017291:Clarithromycin