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last
update October 2002
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| Mycobacterium
avium Complex Infection: Liver Biopsy |
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Mycobacterium
avium complex
(MAC) is a ubiquitous organism that is commonly found in food
and water. Disseminated infection manifests as fever, weight loss,
adenopathy, diarrhea, anemia, neutropenia, and increased liver
function tests. Treatment consists of a combination of three drugs,
often clarithromycin, ethambutol, and rifabutin.
Primary prophylaxis for MAC is recommended in patients with a
CD4 count less than 50. Azithromycin 1200 mg once per week or
clarithromycin 500 mg twice a day are the drugs of choice. Gastrointestinal
toxicity is common with both drugs. Rifabutin is also effective
for MAC prophylaxis but less so than the macrolides. In addition,
rifabutin interacts with protease inhibitors and efavirenz, making
it difficult to co-administer with combination antiretroviral
therapy.
Primary MAC prophylaxis can be safely discontinued in HIV-infected
patients if their CD4 count rises above 100 for at least three
months on combination antiretroviral therapy. Secondary prophylaxis
can be safely discontinued if they have completed a twelve month
course of treatment and their CD4 count rises above 100 for at
least six months. |
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