MAC prophylaxis in the era of polypharmacy.

In the advanced stages of AIDS, patients are increasingly susceptible to disseminated Mycobacterium avium-intracellulare (MAC) infection, causing significant morbidity and mortality. It has been shown that prophylaxis against this infection is effective in reducing the incidence as well as the symptoms of MAC. Although chemoprophylaxis against MAC is a standard recommendation, it is not always carried out due to a variety of reasons. Several agents are now approved for this purpose, adding to the complexity of the decision to start the prophylaxis. This article reviews the need for prophylaxis against MAC, and considers the different agents available, with the aim of helping readers come to an informed decision about starting MAC prophylaxis in their patients. This issue will be of rising importance with the effective prevention of other opportunistic infections in patients with advancing immune deficiency.