"How do I manage disseminated Mycobacterium avium complex (MAC) disease in people with HIV?"
AIDS
Disseminated MAC
Late presentation
treatment: rifamycins
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
27 Aug 2024
27 Aug 2024
Historique:
received:
04
07
2024
revised:
04
08
2024
accepted:
22
08
2024
medline:
31
8
2024
pubmed:
31
8
2024
entrez:
29
8
2024
Statut:
aheadofprint
Résumé
Advanced HIV disease (AHD) is increasing, with late presentation accounting for half of newly diagnosed people with HIV (PWH) in Europe. Mortality in late-presenting PWH remains high, and Mycobacterium avium complex (MAC) disease, among other opportunistic infections, presents several diagnostic and treatment challenges that lead, ultimately, to a poor clinical outcome. We aimed to provide guidance on the diagnosis and treatment of disseminated MAC disease (dMACd) in PWH. We performed a review of original articles, meta-analyses, and systematic reviews retrieved from PubMed. We reviewed and discussed the most challenging steps in the management of PWH with AHD and dMACd: the current epidemiology in the era of effective antiretroviral treatment (ART); clinical presentation and interpretation of symptoms in the context of other opportunistic infections and immune reconstitution; diagnosis, sampling, and timing to reach a definitive diagnosis; prophylaxis, treatment options, and indications for discontinuing MAC treatment; future perspectives, and the role of rifamycins in the treatment of dMACd. Despite the widespread availability of effective ART, dMACd still represents a major cause of morbidity and mortality in PWH with AHD. Residual challenges are mainly related to the difficulties and timing required to reach a definitive diagnosis, and the discussion regarding the role of rifamycins in the treatment of dMACd is still open.
Sections du résumé
BACKGROUND
BACKGROUND
Advanced HIV disease (AHD) is increasing, with late presentation accounting for half of newly diagnosed people with HIV (PWH) in Europe. Mortality in late-presenting PWH remains high, and Mycobacterium avium complex (MAC) disease, among other opportunistic infections, presents several diagnostic and treatment challenges that lead, ultimately, to a poor clinical outcome.
OBJECTIVES
OBJECTIVE
We aimed to provide guidance on the diagnosis and treatment of disseminated MAC disease (dMACd) in PWH.
SOURCES
METHODS
We performed a review of original articles, meta-analyses, and systematic reviews retrieved from PubMed.
CONTENT
BACKGROUND
We reviewed and discussed the most challenging steps in the management of PWH with AHD and dMACd: the current epidemiology in the era of effective antiretroviral treatment (ART); clinical presentation and interpretation of symptoms in the context of other opportunistic infections and immune reconstitution; diagnosis, sampling, and timing to reach a definitive diagnosis; prophylaxis, treatment options, and indications for discontinuing MAC treatment; future perspectives, and the role of rifamycins in the treatment of dMACd.
IMPLICATIONS
CONCLUSIONS
Despite the widespread availability of effective ART, dMACd still represents a major cause of morbidity and mortality in PWH with AHD. Residual challenges are mainly related to the difficulties and timing required to reach a definitive diagnosis, and the discussion regarding the role of rifamycins in the treatment of dMACd is still open.
Identifiants
pubmed: 39209269
pii: S1198-743X(24)00421-X
doi: 10.1016/j.cmi.2024.08.022
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Conflict of interest All the authors declare no conflicts of interests. No fundings were received by the authors for this manuscript. Authors’ contributions. Conceptualization: TM, AG and NR; Methodology: AB, SN, AG and NR; Resources and data curation: TM, GP and ARR; Writing, reviewing and editing: TM, GP, AR, SN, AG and NR; Supervision: AB, SN, AG and NR.