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Is primary mycobacterium avium complex prophylaxis necessary in patients with CD4 <50 cells/μL who are virologically suppressed on cART?
- Source :
-
AIDS patient care and STDs [AIDS Patient Care STDS] 2014 Jun; Vol. 28 (6), pp. 280-3. Date of Electronic Publication: 2014 May 15. - Publication Year :
- 2014
-
Abstract
- We analyzed 369 patients with no prior Mycobacterium avium complex (MAC) infection and CD4 <50 cells/μL (baseline), while on combination antiretroviral therapy(cART), for incidence rates of primary MAC infection during the 6 months after baseline, by prophylaxis status. Of participants (median age, 40 years old), most were male (81%) and about half were non-white; at baseline, 81% of participants were on cART >60 days and 19% had HIV RNA <1000 copies/mL, whereas 65% had HIV RNA >10,000 copies/mL. Eleven patients had MAC infection within 6 months baseline (rate=0.6/100 person months): 4/175 on MAC prophylaxis vs. 7/194, no MAC prophylaxis (p=0.64). Of the 11 patients, seven had HIV RNA >10,000, and three >1000-9999 copies/mL at baseline (one missing). Median time to MAC infection was 62 days (IQR 43-126, maximum 139 days). No MAC infection occurred among 71 (19%) patients virologically suppressed (HIV RNA <1000 copies/mL) at baseline, including 41 patients with no MAC prophylaxis during follow-up. A small number of eligible virologically suppressed participants and the lack of data on cART/MAC prophylaxis adherence limited our observational nonrandomized study. Primary MAC prophylaxis may not be required for cART-virologically suppressed patients with CD4 <50 cells/mL.
- Subjects :
- AIDS-Related Opportunistic Infections complications
AIDS-Related Opportunistic Infections epidemiology
Adult
Aged
Anti-HIV Agents administration & dosage
Anti-HIV Agents therapeutic use
Antiretroviral Therapy, Highly Active
Azithromycin therapeutic use
Clarithromycin therapeutic use
Female
Follow-Up Studies
HIV Infections immunology
Humans
Incidence
Male
Middle Aged
Mycobacterium avium Complex
Mycobacterium avium-intracellulare Infection complications
Mycobacterium avium-intracellulare Infection epidemiology
RNA, Viral blood
Retrospective Studies
Rifabutin therapeutic use
United States epidemiology
Viral Load
AIDS-Related Opportunistic Infections prevention & control
Anti-Bacterial Agents therapeutic use
Antibiotic Prophylaxis
CD4 Lymphocyte Count
HIV Infections drug therapy
Mycobacterium avium-intracellulare Infection prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1557-7449
- Volume :
- 28
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- AIDS patient care and STDs
- Publication Type :
- Academic Journal
- Accession number :
- 24833016
- Full Text :
- https://doi.org/10.1089/apc.2013.0270