Impact of clarithromycin and azithromycin on patterns of treatment and survival among AIDS patients with disseminated Mycobacterium avium complex

Objective: To determine the impact of the introduction of clarithromycin and azithromycin on the treatment and survival of patients with AIDS and disseminated Mycobacterium avium complex (DMAC). Design: Retrospective review over a 3.5-year interval. Setting: Tertiary-care, university teaching hospital. Patients: Charts of all patients with cultures of blood or bone-marrow positive for acid-fast bacilli (n=103) were reviewed. Data on laboratory results at the time of DMAC diagnosis, antimycobacterial therapy, antiretroviral therapy, and survival was collected. Results: Prior to the availability of clarithromycin and azithromycin 61.5% of patients received antimycobacterial treatment compared with 92% afterwards (P=0.0014). Median survival of treated patients was 255 versus 145 days for untreated patients (P<0.001). Median survival of macrolide-treated patients was 284 versus 168 days for patients receiving treatment without a macrolide (P=0.09). Univariate predictors of survival were antimycobacterial treatment, use of antiretrovirals, and year of diagnosis. In a multivariate model, no antimycobacterial treatment (hazard ratio, 3.83; P=0.003) was associated with shorter survival, and treatment without a macrolide (hazard ratio, 2.29; P=0.075) showed a trend towards shorter survival versus treatment with macrolide-containing regimens. Conclusions: The introduction of clarithromycin and azithromycin has been associated with an increase in the proportion of patients with DMAC receiving treatment and with increased survival of these patients