Therapeutic options for the management and prevention of Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome.

Atypical mycobacteria that cause disseminated disease result in significant morbidity and mortality among patients with advanced human immunodeficiency viral infection. Although significant progress has been made with respect to our understanding of the epidemiology, microbiology, and pathogenesis of Mycobacterium avium complex (MAC) infections in patients with the acquired immunodeficiency syndrome (AIDS), treatment and prevention strategies are still emerging. A series of case-controlled studies and clinical trials evaluated various combinations of traditional and investigational antimycobacterial agents, and demonstrated modest clinical and microbiologic success in the treatment of disseminated MAC infection. Prevention studies proved rifabutin and clarithromycin to be rational prophylaxis agents. Continued identification of optimum combination regimens remains essential to curtail the increasing frequency of disseminated MAC disease in patients with AIDS.