Mycobacterium avium complex infection in the acquired immunodeficiency syndrome

Article Abstract:

Mycobacterium avium was first considered to be an infectious agent that colonized in very ill AIDS patients, but it is now recognized as an organism capable of contributing significantly to the illness and death of these patients. A review is presented of the epidemiologic features, pathogenesis, clinical manifestations, and treatment of disseminated Mycobacterium avium complex infection, which is made up of Mycobacterium avium and Mycobacterium intracellulare. The frequency of this infection has increased steadily as the number of AIDS cases has grown. Possible explanations include the fact that the bacteria can now be more easily grown under laboratory conditions, making diagnoses more accurate; diagnoses may have not been pursued earlier because many believed no effective treatment was available; and AIDS patients under zidovudine treatment survive longer, remaining vulnerable to such infections longer. Disseminated Mycobacterium avium complex infection strikes between 15 and 24 percent of AIDS patients. By the end of 1990, it had affected between 24,000 and 39,000 people. Those with severely impaired immune systems are vulnerable. Hispanics seem less likely than non-Hispanic whites or blacks to contract this infection; differences for sex or route of acquisition of human immunodeficiency virus infection do not seem to affect the incidence. Because AIDS patients, with impaired cell-mediated immunity (mediated by T cells, the main cell type of the cellular branch of the immune system), are so susceptible to Mycobacterium avium, it can be inferred that this type of immunity constitutes the normal form of defense. Infected patients usually develop a persistent fever, possibly with night sweats and weight loss; chronic diarrhea, anemia (abnormally low level of red blood cells) and abdominal pain are other signs. A diagnosis of disseminated Mycobacterium avium complex infection can be made by cultures of blood, bone marrow, lymph node, or liver tissue; ultimately, many organs become infected. Recent reports indicate some success in treating the infection with several antibacterial agents given simultaneously, but some symptoms (fever, night sweats) are more affected than others (anemia). The potential benefits of antimycobacterial agents must be weighed against their toxic side effects. Promising new drugs are described. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Risk factors, Diseases, AIDS patients, Mycobacterium avium

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Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection

Article Abstract:

Thalidomide can heal aphthous ulcers in AIDs patients but it may also increase HIV levels. Aphthous ulcers are painful ulcers that can occur inside the mouth. Researchers randomly assigned 57 HIV patients with oral aphthous ulcers to take thalidomide or placebo for four weeks. Over half the patients taking thalidomide had healed completely by four weeks, compared to only 7% of those taking a placebo. However, thalidomide also increased HIV RNA levels, probably by increasing the production of tumor necrosis factor. The drug should be stopped as soon as the ulcers are healed.

Drug therapy, Stomatitis, Aphthous, Canker sores, Thalidomide

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Advances in the prevention and treatment of Mycobacterium avium disease

Article Abstract:

Drugs to prevent Mycobacterium avium complex infection in AIDS patients appear to be more cost-effective than waiting until the patient develops the infection and treating it. Two 1996 studies indicate that the antibiotics clarithromycin and azithromycin can substantially reduce the risk of Mycobacterium avium infection. Both are more effective than rifabutin. However, they may interact with other drugs the patient is taking. Once a patient develops the infection, clarithromycin, ethambutol and rifabutin should be used to treat it.

Editorial, Prevention, Mycobacterium avium complex, Azithromycin, Clarithromycin

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