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MAC Prophylaxis Is Unnecessary When CD4 Counts Rise

Prophylaxis with weekly doses of azithromycin can be effective against Mycobacterium avium complex (MAC) infections in people suffering from late-stage HIV infections. Results from this U.S. multicenter study indicate that it is safe to withdraw prophylaxis once CD4 cell counts rise in response to antiretroviral therapy.

A total of 520 patients whose median CD4 cell counts had risen from 23/mm³ to 225/mm³ during antiretroviral therapy were randomized to weekly azithromycin or to placebo. No patients had histories of MAC infections; 278 (53 percent) had not received MAC prophylaxis prior to study entry. All patients had CD4 cell counts higher than 100/mm³.

During a median 12-month follow-up, no patients in either group developed MAC infections. Other AIDS-related opportunistic infections occurred in 14 patients assigned to azithromycin and in 13 assigned to placebo. The incidence of bacterial infections was similar in the 2 groups, as was mortality (1.9 percent in each group).

Comment: Primary MAC prophylaxis, like primary Pneumocystis carinii pneumonia (PCP) prophylaxis, can be stopped safely when CD4 cell counts respond to antiretroviral therapy. Whether these results apply to patients receiving multidrug treatment for MAC awaits further data, but studies have shown that both secondary PCP and cytomegalovirus prophylaxis can safely be discontinued in these circumstances -- it seems likely that the same will hold for MAC.

— A Zuger

Published in Journal Watch General Medicine April 18, 2000

Citation(s):

El-Sadr WM et al. Discontinuation of prophylaxis for Mycobacterium avium complex disease in HIV-infected patients who have a response to antiretroviral therapy. N Engl J Med 2000 Apr 13 342 1085-1092.

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