Important note: Information in this article was accurate in September 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, September 4, 2000
Prepared by AIDS Weekly editors from staff and other reports
NewsRx -- Researchers in Switzerland find that discontinuing primary prophylaxis against disseminated Mycobacterium avium infection (MAC) in HIV infected patients who are responding well to highly active antiretroviral therapy (HAART) is safe.
H. Furrer and colleagues, University Hospital of Bern, conducted a prospective, multicenter cohort study to determine if eliminating primary prophylaxis against disseminated MAC in HIV patients on HAART would be safe.
"HIV infected patients were eligible for the analysis if: (i) they had a history of at least two CD4 cell counts <50x106/l; (ii) they had never had MAC; (iii) they had discontinued or never begun primary prophylaxis against MAC; (iv) they received antiretroviral therapy and demonstrated an increase in CD4 cell counts to greater than or equal to 100x106/l that was sustained for at least 12 weeks," wrote Furrer et al. ("Discontinuing or withholding primary prophylaxis against Mycobacterium avium in patients on successful antiretroviral combination therapy. The Swiss HIV Cohort Study," AIDS 2000 Jul 7;14(10):1409-12.
The researchers measured incidence of disseminated MAC disease from the beginning of the study until the last follow-up. Confidence intervals (CI; 99%) were calculated assuming a Poisson distribution of events.
Of those entered in the trial, 253 patients were eligible for analysis. The median age of the patients was 37 years, 22.5% were female, 30% were injecting drug users, 66% were in U.S. Centers for Disease Control and Prevention (CDC) stage C, and 28% were in CDC stage B.
The patients' median nadir CD4 cell count was 10x106/l and the median duration of the CD4 cell count at <50x106/l was 12 months, added Furrer et al.
There were not any cases of disseminated MAC during the total follow-up period, which comprised 364.3 patient-years. They reported that the one-sided 99% confidence limit for incidence density of MAC was 1.3 per 100 person-years.
"Discontinuing or withholding primary prophylaxis against MAC is safe in patients who have a sustained increase in their CD4 cell count to greater than or equal to100x106/l," concluded Furrer et al.
The contact person for this report is H. Furrer, University Hospital of Bern, Division of Infectious Diseases, CH-3010 Bern, Switzerland.
A search of the www.NewsRx.com online database using the terms "MAC" and "prophylaxis" generated 56 articles.
Key points reported in this study are:
This article was prepared by AIDS Weekly editors from staff and other reports.
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