title: High recurrence rate supports need for secondary prophylaxis in non-HIV patients with disseminated mycobacterium avium complex infection: a multi-center observational study.
abstract: BACKGROUND
  Long-term outcomes in non-HIV immunocompromised patients with disseminated Mycobacterium avium complex (dMAC) infections are unknown and the need for post-treatment secondary prophylaxis against MAC is uncertain in this setting. The objective of this study was to determine the need of continuing secondary anti-MAC prophylaxis in non-HIV patients after completing treatment of the primary dMAC episode.
  
  
  METHODS
  We conducted a ten-year multi-center analysis of non-HIV immunosuppressed patients with dMAC infections in Hong Kong.
  
  
  RESULTS
  We observed sixteen patients with dMAC during the study period of which five (31 %) were non-HIV immunosuppressed patients. In the non-HIV immunosuppressed group, three patients completed a treatment course without secondary prophylaxis, one patient received azithromycin-based secondary prophylaxis and one patient was still receiving therapy for the first dMAC episode. All the three patients who completed treatment without being given secondary prophylaxis developed recurrent dMAC infection requiring retreatment.
  
  
  CONCLUSIONS
  In view of the high rate of dMAC infection recurrence in non-HIV immunocompromised patients following treatment completion, our data support long-term anti-MAC suppression therapy after treatment of the first dMAC infection episode in immunocompromised non-HIV patients, as is recommended for patients with advanced HIV. Tests of cell mediated immune function need to be evaluated to guide prophylaxis discontinuation in non-HIV patients.
authors: Department of Microbiology, The University of Hong Kong, Hong Kong, China.
authors: Siddharth
authors: S
authors: Sridhar
authors: Department of Microbiology, United Christian Hospital, Hong Kong, China.
authors: Kitty S C
authors: KS
authors: Fung
authors: State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.|Department of Microbiology, The University of Hong Kong, Hong Kong, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.|Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China.
authors: Jasper F W
authors: JF
authors: Chan
authors: Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors: Jimmy Y W
authors: JY
authors: Lam
authors: Department of Microbiology, Tuen Mun Hospital, Hong Kong, China.
authors: Eric K T
authors: EK
authors: Yip
authors: Division of Infectious Disease, Department of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Ivan F N
authors: IF
authors: Hung
authors: Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors: Alan K L
authors: AK
authors: Wu
authors: Department of Microbiology, Tuen Mun Hospital, Hong Kong, China.
authors: Tak-Lun
authors: TL
authors: Que
authors: State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.|Department of Microbiology, The University of Hong Kong, Hong Kong, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.|Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China.
authors: Susanna K P
authors: SK
authors: Lau
authors: State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk.|Department of Microbiology, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk.|Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk.
authors: Patrick C Y
authors: PC
authors: Woo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D017963:Azithromycin / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections; D006723:Hong Kong; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy* / Q000517:prevention & control; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin