A 38-year-old HIV-positive woman with CD4 count 22 cells/μL has 3 weeks of intermittent fever, night sweats, abdominal pain and progressive weight loss. Blood cultures drawn from peripheral veins grow acid-fast bacilli later identified as Mycobacterium avium complex. What is the preferred initial treatment?

• A Azithromycin plus ethambutol ✓
• B Isoniazid plus rifampicin plus pyrazinamide
• C Amikacin monotherapy for 6 weeks
• D Clarithromycin plus ciprofloxacin

Explanation

Disseminated MAC in advanced AIDS is treated with a macrolide (azithromycin or clarithromycin) plus ethambutol; adding rifabutin may be considered with heavy bacteraemia. Standard antituberculous drugs have no activity against MAC, amikacin is not monotherapy, and fluoroquinolones are weak agents used only as third drugs. Prophylaxis with weekly azithromycin is indicated once CD4 falls below 50 cells/μL.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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