IDSA Recommendations for Preventing and Treating Disseminated Mycobacterium Avium Complex in HIV-AIDS Preventing 1st Episode of Disseminated MAC Disease (Primary Prophylaxis): Indications for Initiating Primary Prophylaxis: • CD4 count <50 cells/mm3 after ruling out disseminated MAC disease based on clinical assessment (which may include mycobacterial blood culture for some patients) (AI) Preferred Therapy: • Azithromycin 1200 mg PO once weekly (AI), or • Clarithromycin 500 mg PO BID (AI), or • Azithromycin 600 mg PO twice weekly (BIII) Alternative Therapy: • Rifabutin 300 mg PO daily (BI) (dosage adjusted may be necessary based on drug-drug interactions, please refer to Table 5 for dosing recommendation when used with ARV drugs). Note: Active TB should be ruled out before starting rifabutin. Indication for Discontinuing Primary Prophylaxis: • CD4 count >100 cells/mm3 for ≥3 months in response to ART (AI) Indication for Restarting Primary Prophylaxis: • CD4 count <50 cells/mm3 (AIII) Treating Disseminated MAC Disease Preferred Therapy: At least 2 drugs as initial therapy to prevent or delay emergence of resistance (AI) • Clarithromycin 500 mg PO twice daily (AI) + ethambutol 15 mg/kg PO daily (AI), or • Azithromycin 500–600 mg (AII) + ethambutol 15 mg/kg PO daily (AI) when drug interactions or intolerance precludes the use of clarithromycin #Mycobacterium #AviumComplex #MAC #IDSA #Prevention #Treatment #management #opportunistic #infections #HIVAIDS #pharmacology
