Treatment Review #15; December 1994

The symptoms of MAC can include weight loss, fevers, chills, night sweats, swollen glands, abdominal pains, diarrhea and overall weakness. MAC usually affects the intestines and inner organs first, causing liver tests to be high. Swelling and inflammation also occur.

A multi-center trial has shown that rifabutin, or Mycobutin, can nearly cut in half the rate at which people develop MAC. The drug is approved for prevention of MAC. The most serious side effects of rifabutin are low white blood-cell counts and elevated liver enzymes. Very few people in trials had to discontinue the drug because of toxicity. Other side effects of rifabutin can be kidney and liver complications, and an inflammation of the eye called uveitis.

Uveitis can cause blindness. If you are taking rifabutin, be sure and report any eye complications to your doctor right away. Symptoms of uveitis include eye pain, light sensitivity, redness and blurred vision.

Rifabutin is also being studied as part of a combination of drugs for treating MAC in people with less than 200 T4 cells. Just a few years ago, may doctors thought MAC was untreatable. There is no standard treatment approved for MAC infection. Most doctors use two to five drugs in combination. All the drugs are antibiotics. Combination drug treatments are used because MAC can become resistant to single treatments. By using drugs in combination, the doctor hopes to avoid resistance to treatment. If you're taking AZT, the rifabutin can affect the amount of AZT in your blood. A decreased available amount of AZT would make the AZT less effective against HIV.

Researchers in London have seen antibiotic-associated diarrhea and colitis after treatment with antibiotics, including rifampicin. Rifampicin is related to rifabutin. When rifabutin was used to treat 22 HIV+ people known or thought to have MAC infections, four of the people developed Clostridium difficile-associated diarrhea. Two of those people went on to develop colitis. Both infections are very difficult to treat. Because the incidence of antibiotic- associated diarrhea/colitis with rifabutin is unkown, the researchers caution against its widespread use until this association is clarified. Biaxin, or clarithromycin, is used almost as much as rifabutin for treatment and prevention. Clarithromycin may lower levels of rifabutin and AZT in the blood. Other side effects of clarithromycin can be stomach pain, diarrhea, and change in taste.

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