Gordin F, Masur H
Division of Infectious Diseases, Veterans Administration Medical Center, Washington, D.C. 20422.
Clin Infect Dis. 1994 Apr;18 Suppl 3:S223-6. doi: 10.1093/clinids/18.supplement_3.s223.
Prevention of opportunistic infections is an integral part of caring for patients infected with human immunodeficiency virus. Mycobacterium avium complex (MAC) bacteremia can cause severe morbidity and excess mortality among these patients. Controlled trials of rifabutin for the prophylaxis of MAC bacteremia have been completed. Rifabutin reduced the incidence of MAC bacteremia by approximately one-half and, when disseminated disease due to MAC (DMAC) did develop, reduced the frequency of associated clinical symptoms. Moreover, prophylaxis with rifabutin was well tolerated. Prophylaxis of MAC bacteremia with macrolide antibiotics is currently being investigated, but no data from large-scale prospective trials are yet available. On the basis of trials completed thus far, the U.S. Public Health Service has recently recommended the use of rifabutin (300 mg/d) as prophylaxis for MAC bacteremia in patients with fewer than 100 CD4+ lymphocytes/mm3. The widespread use of this prophylactic regimen could reduce the rates of morbidity and mortality caused by DMAC. However, rifabutin must be administered only after careful consideration of the circumstances of individual patients. Potential drug interactions, cost, and compliance are important factors in the decision about which patients should receive prophylaxis.
预防机会性感染是护理感染人类免疫缺陷病毒患者的一个重要组成部分。鸟分枝杆菌复合体（MAC）菌血症可导致这些患者出现严重发病和额外死亡。关于利福布汀预防MAC菌血症的对照试验已经完成。利福布汀使MAC菌血症的发生率降低了约一半，并且当因MAC导致播散性疾病（DMAC）确实发生时，减少了相关临床症状的发生频率。此外，利福布汀预防耐受性良好。目前正在研究用大环内酯类抗生素预防MAC菌血症，但尚无大规模前瞻性试验的数据。根据迄今为止完成的试验，美国公共卫生服务部最近建议，对于CD4+淋巴细胞计数低于100/mm³的患者，使用利福布汀（300毫克/天）预防MAC菌血症。广泛使用这种预防方案可降低DMAC所致的发病率和死亡率。然而，利福布汀必须在仔细考虑个体患者情况后才能给药。潜在的药物相互作用、成本和依从性是决定哪些患者应接受预防的重要因素。
