Famularo G, De Simone C, Tzantzoglou S, Coco F
Cattedra di Medicina Interna, Università degli Studi de L'Aquila.
Ann Ital Med Int. 1994 Oct-Dec;9(4):249-54.
Since Mycobacterium avium complex (MAC) infects most, if not all, HIV-positive patients, effective regimens for its treatment and prophylaxis are a necessity. We review here the available literature in an attempt to establish clear-cut criteria for the administration of antibiotics and immunotherapy and for the prophylactic treatment of MAC infections. Several antibiotics, chiefly in combination regimens, are active against MAC. Recent data indicate rifabutin as a first-line antibiotic for the treatment of MAC infections. However, since this antibiotic accelerates hepatic metabolism of many drugs (zidovudine in particular), it has the potential to reduce their serum concentrations and hence limit their antiviral activity. Moreover, rifabutin is active against retroviruses only at extremely high concentrations which are not reached in vivo at normally-prescribed dosages. The recent demonstration that the cytokine interferon-gamma (IFN-gamma) in combination with conventional antibiotic therapy may be effective for disseminated MAC infections indicates that immunotherapy could play a pivotal role in the treatment of MAC infections. Lifetime prophylaxis with rifabutin (300 mg/die) is advised for all patients with HIV infection and fewer than 100 CD4 T lymphocytes/mm3 in the peripheral blood: this antibiotic regimen significantly reduces the frequency of disseminated MAC infections. Further studies are required to evaluate the effectiveness of other prophylactic regimens such as azithromycin and clarithromycin. We conclude that rifabutin and immunotherapy with IFN-gamma will play a key role in the treatment of MAC infections.
由于鸟分枝杆菌复合体（MAC）会感染大多数（即便不是全部）HIV阳性患者，因此有必要采用有效的治疗和预防方案。我们在此回顾现有文献，试图为抗生素和免疫疗法的应用以及MAC感染的预防性治疗确立明确标准。几种抗生素，主要是联合用药方案，对MAC有活性。近期数据表明利福布汀是治疗MAC感染的一线抗生素。然而，由于这种抗生素会加速许多药物（尤其是齐多夫定）的肝脏代谢，它有可能降低这些药物的血清浓度，从而限制其抗病毒活性。此外，利福布汀仅在极高浓度下才对逆转录病毒有活性，而在正常规定剂量下体内无法达到这一浓度。近期有证据表明，细胞因子干扰素-γ（IFN-γ）联合传统抗生素疗法可能对播散性MAC感染有效，这表明免疫疗法在MAC感染的治疗中可能起关键作用。建议所有外周血CD4 T淋巴细胞少于100/mm³的HIV感染患者终身服用利福布汀（300毫克/日）进行预防：这种抗生素方案可显著降低播散性MAC感染的发生率。还需要进一步研究来评估其他预防方案（如阿奇霉素和克拉霉素）的有效性。我们得出结论，利福布汀和IFN-γ免疫疗法将在MAC感染的治疗中发挥关键作用。
