A 42-year-old HIV-positive man (CD4 count 38 cells/μL) presents with fever, night sweats, weight loss, and diffuse micronodular infiltrates on chest X-ray. Blood cultures grow acid-fast bacilli identified as Mycobacterium avium complex. What is the recommended treatment regimen?

• A Isoniazid, rifampicin, pyrazinamide, and ethambutol for 6 months
• B Trimethoprim-sulfamethoxazole double-strength 3 times daily for 3 weeks
• C Amphotericin B followed by fluconazole for 8 weeks
• D Clarithromycin or azithromycin plus ethambutol, with or without rifabutin ✓

Explanation

Disseminated MAC in advanced HIV is treated with a macrolide (clarithromycin or azithromycin) combined with ethambutol, with rifabutin added in some cases. Option A describes RNTCP anti-tuberculosis therapy used for Mycobacterium tuberculosis, not MAC. Option C is for cryptococcal meningitis. Option B is PCP treatment. MAC requires prolonged therapy and immune recovery with ART.

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

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Written and medically reviewed by the StethoPrep medical team.