What is the primary prophylaxis against M avium complex (MAC) in patients with HIV infection?

Updated: Mar 09, 2021
  • Author: Justin R Hofmann, MD; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

Primary prophylaxis for MAC in people living with HIV infection who immediately initiate ART is no longer recommended, regardless of CD4 count (AII recommendation). [1]  This is based on multiple randomized placebo-controlled trials and observational data that found no increased risk of developing MAC in patients taking suppressive ART with or without addition of azithromycin. [37, 38, 39]

Patients who expect a delayed initiation of ART and who have a CD4 count of fewer than 50 cells/μL should be given azithromycin 1200 mg orally weekly after ruling out disseminated MAC infection on clinical assessment (AI recommendation). Alternatives include clarithromycin 500 mg orally twice daily (AI recommendation) or rifabutin 300 mg orally daily with drug dose modifications noted above (BI recommendation).


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