Current Strategies for the Prevention and Treatment of Disseminated Mycobacterium avium Complex Infection in Patients with AIDS

Disseminated Mycobacterium avium complex.(MAC) infection is a common opportunistic disease in patients with acquired immunodeficiency syndrome and is associated with significant morbidity and mortality. Macrolides effectively prevented and treated the disease in clinical trials. In general, prophylaxis with clarithromycin or azithromycin is indicated for patients with CD4 cell counts below 50 cells/mm 3 . Treatment of disseminated MAC infection is lifelong and must include two agents with antimycobacterial activity. Clarithromycin plus ethambutol is considered the standard regimen. Potential alternatives are azithromycin, rifabutin, ciprofloxacin, clofazamine, and amikacin. Several factors influence drug selection, such as the patient's immune status, evidence of treatment safety and efficacy, drug interactions, and potential for resistance.