0
Summaries for Patients |

Stopping Treatment with Antibiotics That Prevent Mycobacterium avium Complex Infection in Persons with HIV Infection Who Have Responded Well to Anti-HIV Drugs FREE

[+] Article and Author Information

Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(7):I-16. doi:10.7326/0003-4819-133-7-200010030-00001
Text Size: A A A

What is the problem and what is known about it so far?

Mycobacterium avium complex (MAC) bacteria can cause illness (fevers, low blood counts, diarrhea, abdominal pain, and weight loss) in persons infected with HIV. The CD4+ count is a measure of immune cells; high CD4+ cell counts are better than low ones. When HIV infection causes patients' CD4+ counts to fall below 50 cells per cubic milliliter of blood (cells/mm3), the risk for infection with MAC bacteria increases greatly; guidelines recommend that at that point patients should take antibiotics that prevent MAC infection. Powerful anti-HIV drugs can allow CD4+ cell counts to rise. It is not known, however, whether it is safe to stop treatment with the antibiotics that prevent MAC infection in persons taking anti-HIV drugs once their CD4+ cell counts have risen.

Why did the researchers do this particular study?

To see whether it is safe to stop treatment with antibiotics that prevent MAC infections in persons taking anti-HIV drugs whose CD4+ cell counts have risen to over 100 cells/mm3.

Who was studied?

The investigators studied 643 persons with HIV infection whose CD4+ cell counts had been below 50 cells/mm3 but then rose above 100 cells/mm3 while they were taking anti-HIV treatment.

How was the study done?

The researchers randomly assigned study patients to continue their anti-MAC antibiotics or to take a placebo that looked like the antibiotic but contained no active ingredient. They then followed the patients to see who developed MAC infections; one method they used was testing blood samples for MAC every 8 weeks.

What did the researchers find?

During an average of 16 months, 2 cases of MAC infection occurred among the 321 study patients taking placebo. No MAC infections occurred among the 322 study patients who continued taking anti-MAC antibiotics. However, statistical tests showed that these results could have happened by chance, suggesting that it is safe to stop treatment with antibiotics to prevent MAC infection in persons taking anti-HIV treatment whose CD4+ counts rise above 100 cells/mm3.

What were the limitations of the study?

Because so few MAC infections occurred, this study cannot exclude the possibility that more MAC infections could really occur without anti-MAC antibiotics than with them. In addition, while the study required that participants have CD4+ cell counts above 100 cells/mm3, the average CD4+ cell count was actually 230 cells/mm3. These results may not apply to patients with smaller improvements in CD4+ cell counts.

What are the implications of the study?

Stopping treatment with antibiotics that prevent MAC infection in persons with HIV infection who are taking anti-HIV drugs and whose CD4+ cell counts rise above 100 cells/mm3 does not appear to cause a significant increase in MAC infections.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.

The summary below is from the full report titled “Discontinuation of Mycobacterium avium Complex Prophylaxis in Patients with Antiretroviral Therapy–Induced Increases in CD4+ Cell Count. A Randomized, Double-Blind, Placebo-Controlled Trial.” It is in the 3 October 2000 issue of Annals of Internal Medicine (volume 133, pages 493-503). The authors are JS Currier, PL Williams, SL Koletar, SE Cohn, RL Murphy,AE Heald, R Hafner, EL Bassily, HM Lederman, C Knirsch, CA Benson, H Valdez, JA Aberg, and JA McCutchan .

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.

The summary below is from the full report titled “Discontinuation of Mycobacterium avium Complex Prophylaxis in Patients with Antiretroviral Therapy–Induced Increases in CD4+ Cell Count. A Randomized, Double-Blind, Placebo-Controlled Trial.” It is in the 3 October 2000 issue of Annals of Internal Medicine (volume 133, pages 493-503). The authors are JS Currier, PL Williams, SL Koletar, SE Cohn, RL Murphy,AE Heald, R Hafner, EL Bassily, HM Lederman, C Knirsch, CA Benson, H Valdez, JA Aberg, and JA McCutchan .

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)