Mycobacterium avium complex

Primary prophylaxis against disseminated Mycobacterium avium complex (MAC) disease is no longer recommended for HIV-infected adults who immediately start antiretroviral therapy (ART), regardless of CD4 count.[8]National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Disseminated mycobacterium avium complex disease. 2024 [internet publication]. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/disseminated People with HIV who have CD4 counts <50 cells/microliter and are not receiving ART, or have not responded to ART, or have no options for a fully suppressive ART regimen should receive primary prophylaxis. Azithromycin and clarithromycin are the preferred options for these patients. Rifabutin may be used if the patient cannot tolerate azithromycin or clarithromycin, but drug interactions may complicate its use.[8]National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Disseminated mycobacterium avium complex disease. 2024 [internet publication]. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/disseminated [31]Uthman MM, Uthman OA, Yahaya I. Interventions for the prevention of mycobacterium avium complex in adults and children with HIV. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD007191. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007191.pub2/full http://www.ncbi.nlm.nih.gov/pubmed/23633339?tool=bestpractice.com [ ] How do monotherapies used to prevent Mycobacterium avium complex affect outcomes in people with HIV?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1030/fullShow me the answer [ ] How do different monotherapies used to prevent Mycobacterium avium complex compare in people with HIV?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1019/fullShow me the answer​​​​ MAC disease should be ruled out before starting prophylaxis. Prophylaxis should be delayed until results are available if disseminated MAC is suspected to avoid the risk of drug resistance.[8]National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Disseminated mycobacterium avium complex disease. 2024 [internet publication]. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/disseminated Once initiated, primary prophylaxis can be discontinued when patients are placed on fully suppressive ART.​

Inhaled antigens from aerosolized Mycobacterium avium complex in hot tubs may cause hypersensitivity pneumonitis; avoidance of the causative antigen/environment is the basis of management/prevention of recurrence in these patients.