Antimycobacterial Therapy for Disseminated Mycobacterium avium Complex Infection in Patients With Acquired Immunodeficiency Syndrome
Department of General Internal Medicine, Veterans Affairs Hospital, University of California, San Francisco 94143-0320. Archives of Internal Medicine
(Impact Factor: 17.33).
05/1992; 152(4):813-7. DOI: 10.1001/archinte.1992.00400160109020
BACKGROUND--Antimycobacterial therapy for disseminated Mycobacterium avium complex (DMAC) in patients with acquired immunodeficiency syndrome (AIDS) may ameliorate symptoms and decrease bacteremia. However, no studies have demonstrated improved survival in patients with AIDS treated for DMAC. We assessed the effects of treatment of DMAC on the survival of patients with AIDS. METHODS--We retrospectively reviewed records of patients with AIDS and DMAC seen at two San Francisco, Calif, hospitals between January 1, 1988, and January 1, 1990. The treatment group (N = 76) consisted of patients who received 2 weeks or more of antimycobacterial therapy with at least three agents. The untreated group (N = 74) received either no therapy or isoniazid alone. Patients in both groups lived a minimum of 2 weeks after the diagnosis of DMAC. RESULTS--The median survival in the treatment group was 191 days, compared with 80 days in the untreated group. In a multivariate proportional hazards model (N = 145), both treatment of DMAC (relative hazard = 0.34; 95% confidence interval, 0.23 to 0.51) and treatment with zidovudine (relative hazard = 0.54; 95% confidence interval, 0.36 to 0.82) were associated with improved survival. CONCLUSION--Patients with AIDS and DMAC who are treated with antimycobacterial drugs may survive longer than untreated patients. We recommend that a randomized trial be conducted to evaluate the optimal treatment of DMAC.
Available from: aac.asm.org
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ABSTRACT: therapy. These patients weregiven daily low-dose oraldexamethasone (typically 2mg/day) asadjunctive therapy. Allhad substantial andsustained weight gain(12to50%o ofpre-steroid treatment bodyweight (P< 0.03)), reduction infever, andanimproved senseofwell-being. Theserumalbumin level increased during dexamethasone therapy (from 3.06± 0.59g/dl (mean+ standard deviation) to3.9± 0.22g/dl (P< 0.01)), while theserum alkaline phosphatase level fell (from 368±247U/liter to128+ 43.6 U/liter (P< 0.04)). Further studies ofthe potential roleforcorticosteroids inthemanagement ofdisseminated M.aviumcomplex infections inhuman immunodeficiency virus-infected patients arewarranted. Disseminated Mycobacterium aviumcomplex (MAC)infec- tions occurin15to24%ofhumanimmunodeficiency virus (HIV)-infected patients withadvanced immunodeficiency and arecharacterized byfevers, progressive weight loss, andfailure tothrive (10, 17). Although specific antimycobacterial therapy maybenefit certain ofthese patients (5, 6,10-12), thereported median survival after diagnosis isonly6to8months (10, 12). Long-term low-dose dexamethasone therapy yielded strikingly beneficial results inseveral deteriorating HIV-infected pa- tients onmultidrug antimycobacterial regimens. Experience
Available from: Karla Kerlikowske
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ABSTRACT: Primary care physicians play an important role in identifying and treating bacterial infections in adults infected with the human immunodeficiency virus (HIV). Mycobacterium avium complex and Mycobacterium tuberculosis are pathogens that can cause systemic or local infection in these patients. We review the epidemiology, pathogenesis, clinical presentation, and principles of treatment for these two mycobacterial pathogens. Because M tuberculosis disease is preventable and curable and yet communicable, physicians should maintain a high degree of suspicion for tuberculosis in HIV-infected adults. In comparison, the goal of treating M avium complex in patients with advanced HIV disease is to reduce constitutional symptoms and improve survival.
Available from: ncbi.nlm.nih.gov
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