title: A study of discontinuing maintenance therapy in human immunodeficiency virus-infected subjects with disseminated Mycobacterium avium complex: AIDS Clinical Trial Group 393 Study Team.
abstract: The present nonrandomized prospective study evaluated whether antimycobacterial therapy for disseminated Mycobacterium avium complex (MAC) could be withdrawn from human immunodeficiency virus-infected subjects who experienced immunologic recovery while receiving highly active antiretroviral therapy (HAART). Eligible subjects had received macrolide-based therapy for least 12 months, were asymptomatic for MAC, had received HAART for at least 16 weeks, and had CD4+ T cell counts >100 cells/microL. Forty-eight subjects were enrolled, with a median CD4+ T cell count of 240 cells/microL at the time of discontinuation of MAC therapy. Forty-seven subjects remained MAC free, whereas 1 subject developed localized MAC osteomyelitis. The median duration of follow-up while not receiving therapy was 77 weeks, and the incidence of MAC infection was 1.44/100 person-years (95% confidence interval, 0.04-8.01). Withdrawal of anti-MAC therapy appears to be safe in patients who have been treated with a macrolide-based regimen for at least 1 year and have an immunologic response on HAART.
authors.affiliation: Department of Medicine, Division of Infectious Disease, University of California-San Francisco, San Francisco, CA, USA. jaberg@im.wustl.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Aberg
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Tun
authors.initials: T
authors.lastname: Liu
authors.forename: Howard M
authors.initials: HM
authors.lastname: Lederman
authors.forename: Richard
authors.initials: R
authors.lastname: Hafner
authors.forename: Francesca J
authors.initials: FJ
authors.lastname: Torriani
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Lennox
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dube
authors.forename: Rob Roy
authors.initials: RR
authors.lastname: MacGregor
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000187:drug effects; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000188:drug therapy*; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents