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Safety of Stopping Treatment for Mycobacterium avium Complex Infection in Patients with AIDS FREE

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The summary below is from the full report titled “Successful Discontinuation of Therapy for Disseminated Mycobacterium avium Complex Infection after Effective Antiretroviral Therapy.” It is in the 5 November 2002 issue of Annals of Internal Medicine (volume 137, pages 734-737). The authors are SD Shafran, LD Mashinter, P Phillips, RG Lalonde, MJ Gill, SL Walmsley, E Toma, B Conway, IW Fong, AR Rachlis, KE Williams, GE Garber, WF Schlech III, and F Smaill.

Ann Intern Med. 2002;137(9):I-48. doi:10.7326/0003-4819-137-9-200211050-00004
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What is the problem and what is known about it so far?

HIV-infected patients are susceptible to other infections because the virus itself damages the body's ability to ward off invasion by other germs, even those that are too weak to infect healthy people. These secondary infections by weak germs are known as opportunistic infections. One of the most common opportunistic infections is caused by an organism known as Mycobacterium avium complex (MAC). Effective therapy for HIV infection (which consists of combinations of medications known as highly active antiretroviral therapy [HAART]) partially restores the body's ability to ward off opportunistic infections and has greatly improved the outcome of these infections. As a result of HAART's ability to improve resistance to infection among HIV-infected patients, the U.S. Public Health Service and the Infectious Diseases Society of America have recommended that treatment (or preventive therapy) for most opportunistic infections can be stopped after successful treatment with HAART. On the other hand, they have recommended that treatment for MAC infection be continued indefinitely, no matter how effective the previous response to HAART. Despite this recommendation, some doctors have stopped treatment for MAC infection after the patient has had a good response to HAART.

Why did the researchers do this particular study?

To determine the safety of stopping MAC therapy after patients had a good response to HAART.

Who was studied?

52 HIV-infected patients with previously documented MAC infection whose response to HAART had been favorable and whose therapy for MAC infection had been stopped for at least 4 months.

How was the study performed?

The researchers reviewed medical charts of all patients to determine the type and duration of MAC therapy, the time since stopping this therapy, the patient's response to HAART, which patients survived, and which patients remained free from MAC infection.

What did the researchers find?

The patients had been treated for MAC infection for an average of 32 months and were followed for an average of 20 months after therapy for MAC infection was stopped. Only one patient had recurrent MAC infection, 37 months after stopping treatment for MAC infection. This patient chose to stop taking HAART 2 months before his MAC infection reappeared.

What are the limitations of the study?

Because this is a relatively small study and the information was gathered by looking at charts after the events had taken place, the researchers could not be certain that they had identified all patients with recurrent infections. This study cannot be used to determine the appropriate length of treatment for MAC infection before stopping such therapy.

What are the implications of the study?

Stopping therapy for MAC infection after successful treatment seems to be safe in HIV-infected patients who are responding to HAART. Doctors treating such patients can decrease both the number of pills they prescribe and the cost of treatment.





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