At 12 weeks – response rate same in all 3 arms (~40-50%)
Patients receiving Clarithromycin and Rifabutin had higher relapse rates (24%) vs. 6-7% in the other two arms
Improved survival in patients receiving all three drugs (HR: 0.44)
**Addition of a third or fourth drug should be considered for patients with advanced immunosuppression (CD4 count <50), high mycobacterial loads, or in the absence of effective ART**
"MAC therapy can be safely discontinued in patients with immune reconstitution. The appropriate duration of MAC therapy and the duration of immune reconstitution before stopping treatment have not been determined. However, United States Public Health Service and IDSA guidelines state that at least 12 months of therapy and six months of immune reconstitution may be reasonable parameters."
Posted 05/09/17 09:51:06 AM by Adam Faye
Symptoms: Fever, painful lymphadenitis; can also have worsening lung infiltrates
Treat IRIS like symptoms with NSAIDs; prednisone can be used for short-term if symptoms not improving.
Begin ARVs after the first two weeks of initiating antimycobacterial therapy in patients with disseminated MAC who are treatment naïve or not receiving effective ARV therapy.
Patients are at low risk of recurrence of MAC when they have completed a course of ≥12 months of treatment for MAC, remain asymptomatic with respect to MAC signs and symptoms, and have an increase in their CD4 counts to >100 cells/mm3 that is sustained for >6 months after ART.