Mycobacterium avium complex (MAC) infections in HIV-infected patients
- Judith S Currier, MD
Judith S Currier, MD
- Professor of Medicine
- University of California, Los Angeles
Mycobacterium avium complex (MAC) refers to infections caused by one of two nontuberculous mycobacterial species, either M. avium or M. intracellulare. (See "Microbiology of nontuberculous mycobacteria".)
While infections with these organisms can occur in patients who are not HIV-infected, the frequency of infection increased and the nomenclature MAC was developed early in the HIV epidemic. Dramatic declines in the rate of new MAC cases in HIV-infected patients have accompanied the use of more effective antiretroviral therapy (ART) and the more widespread use of prophylaxis against MAC infection [1-3]. (See "Overview of prevention of opportunistic infections in HIV-infected patients" and "Epidemiology of nontuberculous mycobacterial infections".)
The epidemiology and clinical manifestations of MAC infection and current knowledge about the prevention and therapy of MAC in HIV disease will be reviewed here. MAC infections in patients without HIV are discussed separately. (See "Overview of nontuberculous mycobacterial infections in HIV-negative patients" and "Treatment of nontuberculous mycobacterial infections of the lung in HIV-negative patients".)
Transmission — Mycobacterium avium complex organisms are ubiquitous in the environment, including water and soil . The mode of infection for MAC infection is thought to be through inhalation or ingestion.
Person-to-person or common source transmission of MAC does not appear to be common; there is no need for isolation of hospitalized patients with MAC infection.
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- Risk factors
- Host genetics
- CLINICAL MANIFESTATIONS
- Disseminated infection
- Localized disease
- Effect on HIV infection
- PREVENTION OF MAC DISEASE
- Clarithromycin versus placebo
- Azithromycin comparative trial
- Clarithromycin comparative trial
- Recommended drug choice
- Timing of the initiation of prophylaxis
- Discontinuation of prophylaxis
- General principles
- First-line agents
- Second-line agents
- Addition of third agent
- Addition of antiretroviral therapy
- Adjunctive therapy
- Monitoring of therapy
- Management of treatment failure
- Summary recommendations
- Safety of discontinuing MAC therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS