Mycobacterium Avium Complex (MAC)

Question 1

CD4 count

Answer 1

< 50

Question 2

Transmission

Answer 2

Inhalation, ingestion, inoculation through respiratory and GI tracts

Question 3

Presentation

Answer 3

Gradual onset on symptoms for several months

Fever, NIGHT SWEATS

Question 4

Diagnosis

Answer 4

S/Sx + isolation of MAC from acid-fast bacilli

Physical exam: hepatomegaly, splenomegaly, lymphadenopathy

Lab tests: anemia, elevated liver alkaline phosphatase

Question 5

Treatment

Answer 5

Start ART ASAP

Preferred: Clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily x 12 months
OR
Azithromycin 500-600 + ethambutol 15 mg/kg PO daily x 12 months

Severe: Clarithromycin/azithromycin + ethambutol + rifabutin x 12 months

Consider 4th drug (levofloxacin/moxifloxacin, amikacin/streptomycin, linezolid/tedizolid)
- CD4 < 50 cells/mm3
- High viral loads
- Ineffective ART

Question 6

Prophylaxis

Answer 6

NOT RECOMMENDED

Question 7

Primary prophylaxis

Answer 7

CD4 count < 50 AND not receiving ART–> no disseminated MAC
- Azithromycin 1200 mg PO once weekly

D/C if patient continuing fully suppressive ART

Restart if CD4 count < 50 and not on fully suppressive ART

Question 8

Secondary prophylaxis

Answer 8

Clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily +/- Rifabutin x 12 months

D/C: completed 12 months of therapy, no signs or symptoms, CD4 count > 100 x 6 months on ART

Restart: CD4 count < 100 and no fully suppressive ART