• MAC - Mycobacterium avium complex in HIV-infected patients
  • Infection caused by one of two nontuberculous mycobacterial species:
    • M. avium
    • M. intracellulare
  • Organisms are ubiquitous in the environment, including water and soil
  • Risk of MAC infection in patients with CD4 count <50
  • Azithromycin used for prophylaxis when CD4 count <50
  • Prophylaxis typically stopped when CD4 count recovers to >100
  • Signs/symptoms of disseminated MAC - fever, night sweats, abdominal pain, diarrhea, weight loss
  • Treatment consists of either clarithromycin or azithromycin as the cornerstone of treatment typically with ethambutol+rifabutin
  
  

  Posted 04/27/17 09:37:02 AM by Anna Krigel

• IRIS - Immune Reconstitution Inflammatory Syndrome
  • Generally accepted to be:
    • Worsening of a recognized infection ("paradoxical" IRIS)
    • Or, worsening of an unrecognized pre-existing infection ("unmasking" IRIS)
  • Features that should be present for a diagnosis of IRIS
    • AIDS with low pre-treatment CD4 count (often <100)
    • Positive immunologic response to ART
    • Clinical manifestations consistent with an inflammatory condition
    • Temporal association between HAART initiation and onset of clinical features of illness
  • Pathogens associated with IRIS
    • Mycobacterium tuberculosis
    • MAC
    • CMV
    • Cryptococcus
    • Pneumocystis
    • HSV
    • HBV
    • HHV8
  
  

  Posted 04/27/17 09:51:28 AM by Anna Krigel

• For further reading...

  Prophylaxis against disseminated MAC with azithromycin (NEJM)
  Discontinuation of prophylaxis against MAC disease in HIV-infected patients who have a response to ART (NEJM)
  MAC Treatment (Clinical Infectious Diseases)
  
  

  Posted 04/27/17 09:54:38 AM by Anna Krigel

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