AEGiS-CATIE: INFECTION FIGHTERS: Recovery from MAC infection

INFECTION FIGHTERS: Recovery from MAC infection

TreatmentUpdate60; Volume 7, No. 6 - June 1995
Sean Hosein

* BACKGROUND

As the immune system weakens, people with AIDS become at risk for developing many life-threatening infections including those caused by MAC (Mycobacterium avium complex). One American doctor recently reported 1 case in the USA where his patient apparently recovered from MAC.

* SYMPTOMS AND TREATMENT

On his first visit to the doctor the patient had a fungal infection in the throat and 40 CD4+ cells. He then began to take AZT 500 mg/day. Two months later he was coughing and had to have some X-ray pictures of his chest taken. At first the doctor thought he had tuberculosis and prescribed anti-TB therapy, a combination of isoniazid, rifampin and pyrazinamide. Despite this treatment, he did not improve. A sample of fluid/tissue taken from a lymph node revealed that he was infected with MAC. His prescription was changed to: Cipro 750 mg/day, clofazimine 100 mg/day, ethambutol 15 mg/kg/day "and amikacin 10 mg/kg/day for 2 weeks." He continued to use rifampin 600 mg/day.

* RESULTS

Two months later he stopped coughing, X-ray scans suggested that the infection had not spread and blood levels of liver enzymes fell to near normal levels. The patient also gained 12 lbs. Several months later his doctor stopped prescribing clofazimine and gave him clarithromycin 2 g/day. Six months later all signs and symptoms of MAC infection cleared and he was switched to just azithromycin 500 mg/day. He later developed several parasitic infections while his chest X-ray scans and liver enzyme levels remained normal. He eventually died about 6 months after he started using azithromycin. In a investigation into his cause of death, pathologists could not find any infection with MAC.

REFERENCES:

1. Farber HW. Long-term resolution of disseminated Mycobacterium avium complex infection in a patient with AIDS. Clinical Infectious Diseases 1995;20:1067-1068.

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