II. Epidemiology

  1. Disseminated MAC infection: 40% of North American AIDS
  2. Most common reported HIV Bacterial Infection
  3. Normal Children may develop Lymphadenitis
    1. Occurs under age 5 years
    2. Rarely affects children over age 12 years

III. Pathophysiology

  1. MAC is ubiquitous in environment (water, soil, food)
  2. Causes Tuberculosis in birds and swine
  3. Colonization by respiratory and gastrointestinal tracts
  4. Rarely occurs if CD4 Count >50
  5. Infection in normal children
    1. Breaks in mucus membrane
    2. Tooth Eruption

IV. Symptoms

  1. Fever
  2. Fatigue
  3. Night Sweats
  4. Wasting
  5. Gastrointestinal upset

V. Signs: Normal Children with Lymphadenitis

  1. Chronic unilateral, firm or fluctuant masses

VI. Labs

  1. Alkaline Phosphatase increased
  2. Hemoglobin or Hematocrit consistent with Anemia
  3. Culture
    1. Blood Culture
    2. Bone Marrow Aspirate
    3. Lymph node biopsy
  4. Culture Sites not useful (may represent colonization)
    1. Sputum Culture
    2. Stool Culture
  5. Tuberculin Skin Testing
    1. Negative in 50% normal hosts (without Tuberculosis)

VII. Prevention: Prophylaxis in HIV when CD4 Count < 100

  1. Indicated for CD4 Cell Count < 100
  2. First-line prophylaxis
    1. Azithromycin 1200 mg PO each week
      1. More effective than Rifabutin
  3. Other prophylaxis options
    1. Combination protocol
      1. Azithromycin weekly and
      2. Rifabutin daily
    2. Rifabutin 300 mg/day
      1. Reduces the Incidence of bacteremia by 50%
      2. Risk of Uveitis from rifabutin
    3. Clarithromycin 500 mg PO bid
      1. Decreases MAC infection by 68%
      2. Produces survival benefit

VIII. Management: MAC in HIV

  1. Colonization without bacteremia
    1. Should not be treated
    2. May be candidates for prophylaxis
  2. Treatment
    1. Clarithromycin and 1-2 other active agents
      1. Prevents resistance
    2. Continue drugs for the lifetime of the patient

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