- M. avium complex (MAC) infection is the most commonly occurring mycobacterial infection in AIDS patients and is responsible for significant morbidity in patients with advanced disease (CD4 cell count <100 cells/microliter).
- Disseminated infection with fever, weight loss, and night sweats is the most frequent presentation.
- MAC infection can result in bacteremia in AIDS patients.
- Anemia and an elevated alkaline phosphatase level are the usual laboratory abnormalities.
- Initial therapy should include a macrolide (clarithromycin, 500 mg PO bid) and ethambutol, 15 mg/kg PO daily.
- Rifabutin, 300 mg PO daily, or ciprofloxacin, 500 mg PO bid, can be added in severe cases.
- Secondary prophylaxis for disseminated MAC can be discontinued if the CD count had a sustained increase >100 cells/microliter for 6 months or longer in response to ART, and if 12 months of therapy for MAC is completed and there
- are no symptoms or signs attributable to MAC.