Macrolide Prophylaxis Examined in HIV-Infected Patients

Prophylaxis against mycobacterium avium-intracellulare complex (MAC) is recommended for patients with CD4 counts of 3.

This article is written live from ID Week 2017 Annual Meeting in San Diego, CA. MPR will be reporting news on the latest findings from leading experts in infectious diseases. Check back for more news from IDWeek 2017.

SAN DIEGO—Macrolide prophylaxis is associated with significantly improved survival among Asian HIV-infected patients who have very low CD4 cell counts, according to an analysis presented at IDWeek 2017.

“The benefits of giving macrolide prophylaxis remain despite the availability of effective ART,” concluded Mark Kristoffer Pasayan, MD, of the Research Institute for Tropical Medicine in Muntinlupa, Philippines, and colleagues reported in a poster presentation.

Prophylaxis against mycobacterium avium-intracellulare complex (MAC) is recommended for patients with CD4 counts of <50 cells/mm3, they noted.

“With the significant decrease in incidence of disseminated MAC infection and the effective immune recovery due to the availability of combination antiretroviral therapy (ART), the benefits of giving MAC prophylaxis were investigated,” they explained.

Their study examined how macrolide prophylaxis affected “AIDS-defining conditions and HIV-associated mortality” in a cohort of adult HIV-infected patients with a CD4 count <50 cells/mm3 at initiation of ART, using data from the TREAT Asia HIV Observational Database (TAHOD)

“Of 1,345 eligible patients (78% male with median age at ART initiation of 34.8 years), 10.6% received macrolide prophylaxis,” the study authors reported. “The rates of the combined-outcome and HIV-associated mortality per 100 patient years were 7.35 (95% CI: 6.04–8.95) and 3.14 (95% CI: 2.35–4.19), respectively.”

In multivariate analysis controlling for potentially confounding variables, macrolide use was associated with a significantly decreased risk of HIV-associated mortality (hazard ratio [HR] 0.10; 95% CI: 0.01–0.80, P=0.031), but not the combined outcome.

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Pasayan MK, et al. Effect of Macrolide Prophylactic Therapy on AIDS-Defining Conditions and HIV-Related Mortality. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA.