Combination antiretroviral therapy (cART) has changed
Mycobacterium avium epidemiology. A significant decrease in the
incidence of disseminated M. avium complex (DMAC)
infection was observed between pre-cART and post-cART periods. In contrast,
diagnoses of DMAC more than doubled from 1990 to 1996. During this
time, DMAC
prevalence in people living with
AIDS (PLHA) in
developed countries reached 20-23% overall and >40% in groups with
CD4 cell counts <10
cells/mm3. At present, DMAC in PLHA has an
incidence of two events per 1000
patient years. Recently, the
centers for disease control changed the criteria for MAC primary prophylaxis, where only
patients without immediate cART and
CD4 cell counts <50
cells/mm3 are prescribed 1200 mg of
azithromycin weekly.
Treatment is discontinued when
patients initiate effective cART. Diagnosing a disseminated M. avium
infection is difficult due to the low accuracy of fluid
cultures and a lack of diagnostic processes. However, the usefulness of newer molecular
techniques such as whole-
genome sequencing has not been evaluated for DMAC and
HIV/
AIDS. As DMAC has a high mortality rate if not properly diagnosed and treated, we performed a
literature review of
HIV/
AIDS and DMAC
epidemiology,
risk factors, prophylaxis, clinical manifestation,
diagnosis,
prognosis, and
treatment