TreatmentUpdate59 - Vol 7, No. 5 (May 1995)
Sean Hosein

Infection with MAC (Mycobacterium avium complex) can be a problem for some HIV-infected patients who have less than 75 CD4+ cells. Symptoms can include:

- fever - unintentional weight loss - night sweats - tiredness/low energy - diarrhea

As well, some patients might have high blood levels of liver enzymes such as alkaline phosphatase. Researchers in North America are conducting clinical trials of drugs that may be used to treat patients including:

- azithromycin - clarithromycin - rifabutin

Some researchers think that low doses of corticosteroids (1 to 4 mg/day) such as dexamethasone may be useful in relieving some of the symptoms of MAC infection.

* STUDY DETAILS

All subjects had less than 11 CD4+ cells, unintentional weight loss and fever despite treatment with a combination of 3 antibiotics, one of which was clarithromycin. Technicians detected high blood levels of a liver enzyme (alkaline phosphatase) and low blood levels of protein in the blood samples of subjects. They received 1 to 4 mg/day of dexamethasone orally.

* RESULTS

Subjects had an average weight increase of 31 pounds which lasted for an average of 5 months. Fever decreased as did liver enzyme levels. Blood levels of protein increased. Four subjects received therapy for an average of 9 months, until they died.

* TOXICITY

Doctors stopped giving one subject steroids because he developed the sight-threatening infection CMV retinitis. The drug may also have caused oral yeast infections and possible damage to the pancreas gland in 2 subjects, one of whom developed high blood levels of sugar. Four of these subjects died-perhaps because of several infections that may have been made worse by the corticosteroid. That one subject developed CMV retinitis is not surprising. Doctors in England reported that HIV-infected subjects who used high doses of corticosteroids seemed more likely to develop CMV retinitis. (For details please see TreatmentUpdate 42). The doctors treating this group of 4 subjects suggested that subjects who are using the antibiotics rifampin and 'related' drugs (rifabutin, rifamycin) may need higher doses of corticosteroids.

REFERENCES:

1. Wormser GP, Horowitz H and Dworkin B. Low-dose dexamethasone as adjunctive therapy for disseminated Mycobacterium avium complex infections in AIDS patients. Antimicrobial Agents and Chemotherapy 1994;38(9):2215-2217.

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