AIDS TREATMENT NEWS No. 053 - March 25, 1988
John S. James
He heard that a year ago there were no good treatments, but today there are at least two treatment protocols, each of which combines a new drug with traditional anti-tuberculosis drugs. But physicians differ greatly in their approach to MAI; for example, those on the East Coast are more likely to treat it than those on the West. Most physicians believe that MAI is not life threatening, but a few believe that it kills many people.
Persons with normal immunity can occasionally get pulmonary MAI, but persons with AIDS usually have a systemic infection in the bloodstream; it must be diagnosed by culturing the organisms from the blood. MAI can also affect the bone marrow and cause anemia.
Symptoms include night sweats, high spiking fevers, cough, loss of appetite, and general fatigue. The illness may be misdiagnosed as flu. Often no one suspects MAI until the blood culture is done. Because the organisms grow slowly, the culture takes two weeks.
One treatment now being tested at several California universities combines a new drug, ciprofloxacin, recently made available by prescription, with three older TB drugs: rifampin, ethambutol, and amikacin. The disadvantage of this combination is that amikacin is toxic, and must be given intravenously for a month.
Another treatment combines an experimental drug ansamycin (also called rifabutine, or rifabutin) with ethambutol and clofazimine. This regimen has the advantages of less toxicity, plus the fact that ansamycin may have anti-HIV activity. The disadvantage is that ansamycin must be obtained specially from the Centers for Disease Control; it can take two weeks for delivery, and only a month's supply is sent at one time, so planning is necessary to avoid running out; make sure your physician reorders two weeks in advance each month. (Incidentally we have been hearing good things about ansamycin; it is a drug to watch.)
These treatments do not always work, as there are different organisms which cause MAI, and not all are susceptible to any one drug. Even when the drugs do work, they usually do not kill the organisms completely but reduce their level in the blood. Physicians recommend that treatment be continued indefinitely; unfortunately MAI treatments can sometimes interfere with AZT therapy.
Better treatments for MAI are expected, as a new generation of mycobacteria drugs is now being developed. Meanwhile this disease will become a more serious problem, mainly because fewer people are dying of pneumocystis. MAI develops slowly, and usually occurs, if at all, late in the course of AIDS, often about a year after the first attack of pneumocystis.
Incidentally our friend responded well to the ansamycin (rifabutin) treatment, after six weeks.
For more information about MAI treatments, physicians should check through professional contacts. Also, a number of articles have been published about all of the above drugs in the treatment of MAI or related diseases.
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