| MYCOBACTERIUM AVIUM
COMPLEX
Mycobacterium avium complex, also known as MAC, is a bacterial infection that can be localized (limited to a specific organ or area of the body) or disseminated throughout the body. It is a life-threatening disease, although new treatments offer promise for both prevention and treatment. MAC disease is extremely rare in people who are not infected with HIV, the virus that causes AIDS. Symptoms and Diagnosis Disseminated MAC can affect almost any organ of the body. It can cause symptoms of fever, weight loss, night sweats, fatigue, loss of appetite, loose stools or diarrhea, abdominal pain, anemia (low numbers of red blood cells) and enlargement of the liver or spleen. The symptoms of MAC resemble those of many other conditions in people with AIDS. The diagnosis of MAC is made by identifying the organism in blood samples or tissue from affected organs such as bone marrow or liver tissue. Treatment Acute Therapy. Doctors use a number of different drug combinations to treat MAC. A special task force of the U.S. Public Health Service recommended that at least two drugs be used, one of which should be either azithromycin or clarithromycin. Doctors frequently add one or more of the following as second, third or fourth agents: ethambutol, clofazimine, rifabutin, rifampin, ciprofloxacin and in some situations amikacin. Treatment should continue for life to prevent recurrence of the disease. Preventive Therapy. The USPHS task force also recommended that people with HIV and CD4+ T-cell counts of less than 100 should receive treatment to prevent an initial episode of MAC. (CD4+ T cells are the crucial immune cells targeted by HIV.) Before beginning preventive therapy, people with HIV should be tested to be sure that they do not have active MAC or tuberculosis (TB). Multiple drugs are required to treat these infections because the organisms may become resistant to just one drug. Tests for TB may include an x-ray, tuberculin skin tests and a blood test. Rifabutin is the drug approved for preventive therapy. It is usually well tolerated, but side effects can include low numbers of white blood cells, low platelet count, an eye infection called uveitis, rash and diarrhea. Rifabutin also may alter the metabolism of certain drugs. Source: Public Health Service
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