United Press International - Tuesday, September 28, 1999
Ed Susman

Researchers reported Monday that government-sponsored studies found the risk of contracting Mycobacterium avium complex infections is very low -- provided the patient is on effective antiretroviral therapy.

Before effective antiretroviral therapy to treat AIDS patients became available in the mid-1990s, MAC was one of the most common serious opportunistic infections associated with HIV infection. It caused widespread infection in multiple organs, leading to debilitating symptoms and significantly decreased chances of survival.

But at the Interscience Conference of Antimicrobial Agents and Chemotherapy, an infectious disease meeting of the American Society for Microbiology, doctors said that only two cases of MAC occurred in more than a year among 131 patients who stopped taking the preventive medicine. All the patients continued to take their regular antiviral medication.

Dr. Judith Currier, associate professor of medicine at the University of California, Los Angeles, said the two cases were both 49-year-old men with AIDS.

During the course of disease their CD4 cell counts -- a marker of a weakened immune system -- had dropped to such a low point that they were susceptible to infections such as MAC. Once the men began receiving highly active antiretroviral therapy, their CD4 levels rebounded. Such a change in CD4 cells was required to be eligible for the study, Currier said.

Currier enrolled 643 patients in the study, and eventually 131 were randomized to received placebo rather than the antibiotic azithromycin to control the risk of MAC. None of the patients receiving azithromycin contracted MAC infections.

Currier said that if the incidence of MAC could be reduced to less than 5 percent, researchers would be confident in allowing patients to discontinue prophylactic treatment. The two cases in more than a year fell into the acceptable range, she said.

"The rate of MAC is sufficiently low enough to suggest that withdrawal of MAC prophylaxis poses minimal risk for patients who have sustained CD4 increases," Currier says.

The study was supported by the National Institute of Allergy and Infectious Diseases.

Dr. Mary Romeyn, an AIDS clinician and assistant clinical professor of medicine at the University of California, San Francisco, said: "This report is comforting, and I think it makes sense that these patients can discontinue prophylaxis. I think I will be cautious for a little bit longer for my patients before taking them off azithromycin. Those two infections were particularly ugly cases."
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