Is primary mycobacterium avium complex prophylaxis necessary in patients with CD4 <50 cells/μL who are virologically suppressed on cART?
We analyzed 369 patients with no prior Mycobacterium avium complex (MAC) infection and CD4 <50 cells/μL (baseline), while on combination antiretroviral therapy(cART), for incidence rates of primary MAC infection during the 6 months after baseline, by prophylaxis status. Of participants (median age, 40 years old), most were male (81%) and about half were non-white; at baseline, 81% of participants were on cART >60 days and 19% had HIV RNA <1000 copies/mL, whereas 65% had HIV RNA >10,000 copies/mL. Eleven patients had MAC infection within 6 months baseline (rate=0.6/100 person months): 4/175 on MAC prophylaxis vs. 7/194, no MAC prophylaxis (p=0.64). Of the 11 patients, seven had HIV RNA >10,000, and three >1000-9999 copies/mL at baseline (one missing). Median time to MAC infection was 62 days (IQR 43-126, maximum 139 days). No MAC infection occurred among 71 (19%) patients virologically suppressed (HIV RNA <1000 copies/mL) at baseline, including 41 patients with no MAC prophylaxis during follow-up. A small number of eligible virologically suppressed participants and the lack of data on cART/MAC prophylaxis adherence limited our observational nonrandomized study. Primary MAC prophylaxis may not be required for cART-virologically suppressed patients with CD4 <50 cells/mL.
1 Infectious Disease Research Institute, Inc. , Tampa, Florida.
Bienvenido G
BG
Yangco
Kate
K
Buchacz
Rose
R
Baker
Frank J
FJ
Palella
Carl
C
Armon
John T
JT
Brooks
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D023241:Antiretroviral Therapy, Highly Active; D017963:Azithromycin / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D017291:Clarithromycin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D017828:Rifabutin / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D012367:RNA, Viral; D017828:Rifabutin; D017963:Azithromycin; D017291:Clarithromycin