Complexo Mycobacterium avium

A profilaxia primária contra a doença por complexo Mycobacterium avium (MAC) disseminada não é mais recomendada para adultos e adolescentes infectados por HIV que comecem a terapia antirretroviral (TAR) imediatamente.[30]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. 2019 [internet publication] https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/disseminated Pessoas com HIV e contagens de CD4 >50 células/microlitro e que não recebem TAR ou não respondem a esse tratamento devem receber quimioprofilaxia. O tratamento preferível para esses ´pacientes é a claritromicina ou a azitromicina. A rifabutina pode ser usada se o paciente não conseguir tolerar a azitromicina ou claritromicina, mas as interações medicamentosas podem complicar o seu uso.[30]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. 2019 [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/fullMostre-me a resposta [ ] 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/fullMostre-me a resposta​​​ A doença do complexo Mycobacterium avium (MAC) disseminada deve ser descartada antes de se iniciar a profilaxia, e a infecção por tuberculose ativa deve ser descartada antes de se iniciar a rifabutina.[30]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. 2019 [internet publication] https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/disseminated ​ Uma vez iniciada, a profilaxia primária pode ser descontinuada quando os pacientes são colocados em esquema antirretroviral totalmente supressivo.

Antígenos por via inalatória do complexo Mycobacterium avium aerossolizado em banheiras de hidromassagem podem causar pneumonite por hipersensibilidade; evitar o antígeno/ambiente causador é a base do manejo/prevenção da recorrência nesses pacientes.