To review the pathophysiology, epidemiology, treatment, and prophylaxis of disseminated Mycobacterium avium complex (MAC) infection in HIV-infected individuals.
DATA SOURCES:
A MEDLINE (January 1966–July 1997) and AIDSLINE (January 1980–July 1997) search of basic science articles pertinent to the MAC infection in HIV-infected patients.
STUDY SELECTION AND DATA EXTRACTION:
All articles were considered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion.
DATA SYNTHESIS:
The organism, epidemiology, and pathophysiology of disseminated MAC are discussed for background. A review of clinical trials for the treatment and prophylaxis of disseminated MAC are presented, along with unresolved issues concerning these topics.
CONCLUSIONS:
The incidence of disseminated MAC has increased dramatically with the AIDS epidemic. The infection can lead to increased morbidity and mortality in HIV-infected patients. Treatment regimens for patients with a positive culture for MAC from a sterile site should include two or more drugs, including clarithromycin. Prophylaxis against disseminated MAC should be considered for patients with a CD4 cell count of less than 50/mm3.
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