       Document 0788
 DOCN  M9640788
 TI    Preventing disseminated Mycobacterium avium complex disease in patients
       infected with human immunodeficiency virus.
 DT    9604
 AU    Ostroff SM; Spiegel RA; Feinberg J; Benson CA; Horsburgh CR Jr; Office
       of the Director, Centers for Disease Control and; Prevention (CDC),
       Public Health Service U.S. Department of Health; and Human Services,
       Atlanta, Georgia 30333, USA.
 SO    Clin Infect Dis. 1995 Aug;21 Suppl 1:S72-6. Unique Identifier : AIDSLINE
       MED/96002831
 AB    Disseminated Mycobacterium avium complex (MAC) infection is an important
       late-stage complication of infection with the human immunodeficiency
       virus. Since MAC is widely dispersed in the environment, the source of
       infection for patients with disseminated MAC generally cannot be
       determined. Therefore, specific recommendations for avoiding exposure
       are not supported at this time. Routine screening of stools and sputum
       to detect MAC colonization as a means of targeting prophylaxis for
       disseminated disease is also not recommended at present. Two randomized,
       placebo-controlled trials have demonstrated that prophylactic use of
       rifabutin in persons with low CD4 lymphocyte counts results in a 50%
       decrease in MAC bacteremia as well as a reduction in some signs,
       symptoms, and laboratory abnormalities associated with MAC disease. Thus
       a prophylactic daily dose of rifabutin (300 mg) should be considered for
       adults who have had a previous AIDS-defining opportunistic illness and
       who have a CD4 lymphocyte count of < 75/microL. Many experts would
       consider prophylaxis appropriate only when the CD4 lymphocyte count is <
       50/microL, particularly when there has not been a previous AIDS-defining
       opportunistic infection. Clinicians should be aware of drug interactions
       and potential adverse effects associated with the use of rifabutin.
       Preliminary reports of randomized, placebo-controlled trials suggest
       that chemoprophylaxis with clarithromycin is also effective in the
       prevention of disseminated MAC disease, and evaluation of other agents
       is under way. Prophylaxis for disseminated MAC infection in children has
       not been evaluated but is presumed to be as effective as that in adults.
       Decisions regarding initiation of MAC chemoprophylaxis should be
       individualized.
 DE    Adult  Antibiotics/THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/EPIDEMIOLOGY/*PREVENTION &  CONTROL/TRANSMISSION
       Clarithromycin/THERAPEUTIC USE  Human  Incidence  Mycobacterium
       avium-intracellulare Infection/EPIDEMIOLOGY/  *PREVENTION &
       CONTROL/TRANSMISSION  Rifabutin/THERAPEUTIC USE  Risk Factors  United
       States/EPIDEMIOLOGY  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

