Shafran Stephen D, Mashinter Laura D, Phillips Peter, Lalonde Richard G, Gill M John, Walmsley Sharon L, Toma Emil, Conway Brian, Fong Ignatius W, Rachlis Anita R, Williams Kurt E, Garber Gary E, Schlech Walter F, Smaill Fiona, Pradier C
University of Alberta, Edmonton, Alberta, Canada.
Ann Intern Med. 2002 Nov 5;137(9):734-7. doi: 10.7326/0003-4819-137-9-200211050-00008.
Highly active antiretroviral therapy (HAART) is associated with improvement or resolution of several HIV-associated opportunistic infections. Although prophylaxis against disseminated Mycobacterium avium complex infection may be successfully discontinued after a favorable response to HAART, the 1999 guidelines from the U.S. Public Health Service/Infectious Diseases Society of America recommend continuing therapy for disseminated M. avium complex infection, regardless of the response to HAART.
To examine the outcome among patients with disseminated M. avium complex infection whose antimycobacterial therapy was discontinued after a favorable response to HAART.
Retrospective chart review between May 2000 and May 2001.
13 Canadian HIV clinics.
52 HIV-infected adults (43 men; mean age, 37.3 years) in whom successful antimycobacterial therapy for disseminated M. avium complex infection was discontinued after a favorable virologic response to HAART.
Survival, survival free of disseminated M. avium complex infection, and CD4(+) cell count responses.
At the time of diagnosis of disseminated M. avium complex infection, the median CD4(+) cell count was 0.016 x 10(9) cells/L, and the median plasma HIV RNA level was 90 000 copies/mL (plasma HIV RNA levels were available for only 21 patients). The patients received a median of 32 months of antimycobacterial therapy that included ethambutol plus either clarithromycin or azithromycin. When antimycobacterial therapy was discontinued, the median CD4(+) cell count was 0.23 x 10(9) cells/L and the median plasma HIV RNA level was less than 50 copies/mL. A median of 20 months after discontinuation of antimycobacterial therapy, only 1 patient had developed recurrent M. avium complex disease (37 months after stopping antimycobacterial therapy). This patient had stopped HAART 2 months earlier because of uncontrolled HIV viremia. Twenty months after stopping antimycobacterial therapy, the other 51 patients had a median CD4(+) cell count of 0.288 x 10(9) cells/L; 34 (67%) had undetectable plasma HIV RNA levels, and 8 (15%) had plasma HIV RNA levels of 50 to 1000 copies/mL.
Discontinuation of successful disseminated M. avium complex therapy after a successful response to HAART is safe and reduces patients' pill burdens, potential drug adverse effects, drug interactions, and costs of therapy.
高效抗逆转录病毒疗法（HAART）与多种HIV相关机会性感染的改善或缓解相关。尽管在对HAART产生良好反应后，针对播散性鸟分枝杆菌复合体感染的预防措施可能成功停用，但美国公共卫生服务部/美国传染病学会2000年的指南建议，无论对HAART的反应如何，对于播散性鸟分枝杆菌复合体感染都应继续治疗。
研究在对HAART产生良好反应后停用抗分枝杆菌治疗的播散性鸟分枝杆菌复合体感染患者的结局。
2000年5月至2001年5月的回顾性病历审查。
13家加拿大HIV诊所。
52例HIV感染成人（43例男性；平均年龄37.3岁），这些患者在对HAART产生良好病毒学反应后，成功停用了针对播散性鸟分枝杆菌复合体感染的抗分枝杆菌治疗。
生存率、无播散性鸟分枝杆菌复合体感染的生存率以及CD4(+)细胞计数反应。
在诊断播散性鸟分枝杆菌复合体感染时，CD4(+)细胞计数中位数为0.016×10⁹/L，血浆HIV RNA水平中位数为90000拷贝/mL（仅21例患者有血浆HIV RNA水平数据）。患者接受抗分枝杆菌治疗的中位数为32个月，治疗方案包括乙胺丁醇加克拉霉素或阿奇霉素。当停用抗分枝杆菌治疗时，CD4(+)细胞计数中位数为0.23×10⁹/L，血浆HIV RNA水平中位数小于50拷贝/mL。停用抗分枝杆菌治疗后的中位数为20个月时，只有1例患者发生了复发性鸟分枝杆菌复合体疾病（停用抗分枝杆菌治疗37个月后）。该患者因HIV病毒血症未得到控制，已于2个月前停用HAART。停用抗分枝杆菌治疗20个月后，其他51例患者的CD4(+)细胞计数中位数为0.288×10⁹/L；34例（67%）血浆HIV RNA水平检测不到，8例（15%）血浆HIV RNA水平为50至1000拷贝/mL。
在对HAART产生成功反应后，停用成功的播散性鸟分枝杆菌复合体治疗是安全的，可减轻患者的服药负担、潜在药物不良反应、药物相互作用及治疗费用。
