A patient with HIV (CD4 count 35/µL) develops disseminated Mycobacterium avium complex (MAC) infection with fever, weight loss, diarrhoea, and hepatosplenomegaly. Blood cultures confirm MAC. The first-line prophylaxis for MAC in HIV patients with CD4 <50/µL is:

• A Rifabutin
• B Clarithromycin
• C Azithromycin ✓
• D Ciprofloxacin

Explanation

Current NACO and WHO guidelines recommend azithromycin 1200 mg once weekly as first-line MAC prophylaxis in HIV patients with CD4 <50 cells/µL. Azithromycin has a superior pharmacokinetic profile (long half-life allowing once-weekly dosing), fewer drug-drug interactions with antiretrovirals compared to rifabutin or clarithromycin, and equivalent prophylactic efficacy. Clarithromycin is used for MAC treatment (combination with ethambutol ± rifabutin) but has significant interactions with PIs. Rifabutin is an alternative prophylaxis but requires dose adjustment with many ARVs. Ciprofloxacin has limited MAC activity.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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