Question:

What can you tell me about MAC/MAI? My friend has it in his left lung. He is on IV medication twice a day as well as flutter valve and nebulizer treatments. He also can't seem to put weight on. His doctor has taken him off his HIV medication while treating the MAC. Is this safe? Any information would be very helpful.
Thanks

Answer provided by:

Daniel Lee, M. D.
Assistant Clinical Professor of Medicine
UCSD Medical Center
Owen Clinic

Mycobacterium avium complex (MAC)/Mycobacterium avium intracellulare (MAI) are infections that we can see in people with HIV/AIDS.

The organism that causes these infections are very similar to tuberculosis (known as Mycobacterium tuberculosis). We usually see MAC/MAI in people with CD4 counts less than 50 cells.

MAC/MAI can be found anywhere, but people with poor immune systems are susceptible to getting infections. MAC/MAI can cause infection almost anywhere in the body. It commonly can cause an infection in the blood (known as bacteremia) leading to symptoms of fevers, chills, sweats, and weight loss. MAC/MAI can also affect the stomach/intestines causing diarrhea. It can also affect the bone marrow leading to anemia (low red blood cell counts) causing fatigue or neutropenia (low white blood cell counts) potentially leading to other infections. Much rarer is infection in the lungs, but we do see infection there on occasion.

It can be treated, but usually with multiple medications (at least two, but sometimes more). Some of the MAC/MAI medications may interfere with HIV medications and perhaps that is why his doctor stopped his HIV meds. Another reason may be that his HIV meds may be stopped because he is not able to tolerate all of the HIV meds (due to side effects) in addition to the MAC/MAI meds.

Ultimately, you should probably ask the doctor directly why your friend is not on HIV meds as there may be other reasons. I believe that it is reasonable to hold off on HIV meds at this time and to focus on treatment of the MAC/MAI. However, if your friend can take all of these meds together without any problems or drug interactions, then I believe he should try to take his HIV meds.

I expect that your friend should feel better as the MAC/MAI and HIV continues to be treated.

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