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MAC immune reconstitution disease can recur during HAART
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NEW YORK (Reuters Health) - Even months after apparently successful treatment of Mycobacterium avium complex (MAC) infection, immune reconstitution can recur in HIV-infected individuals being treated with highly active antiretroviral therapy (HAART), physicians report.
Based on their experience with one such patient and a review of the literature, Dr. Joseph A. Desimone, Jr., and colleagues at Thomas Jefferson University in Philadelphia recommend a therapeutic algorithm for treatment of MAC immune reconstitution disease, which they describe in the December issue of AIDS Patient Care and STDs.
Their patient developed lymphadenitis in the neck 5 weeks after starting HAART. Treatment with prednisone for 8 weeks relieved symptoms, but the condition recurred after drug taper. Clarithromycin and ethambutol were prescribed. However, four months later, the lymphadenitis greatly enlarged, and the patient underwent surgical incision and drainage.
Despite apparent cure, the condition again reappeared 6 months later and multiple lymph nodes were removed.
Based on the literature and their own experiences, the team recommends that HAART be continued when MAC is diagnosed. Combination antimycobacterial therapy, based on sensitivity testing, should be initiated.
If the lymphadenopathy is painful, they recommend systemic corticosteroids. If there is no response or suppuration develops, surgical drainage or lymphadenectomy should be performed. Either way, they conclude, HAART and combination antimycobacterial therapy should be continued to prevent postoperative recurrence.
AIDS Patient Care and STDs 2003;17:617-622.
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