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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-. doi: 10.1002/14651858.CD007191.pub2

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Interventions for the prevention of mycobacterium avium complex in adults and children with HIV

This version published: 2013; Review content assessed as up-to-date: January 11, 2013.

Link to full article: [Cochrane Library]

Plain language summary

Mycobacterium avium complex (MAC) infection is a common complication of advanced acquired immunodeficiency syndrome (AIDS) disease and can shorten the survival of these patients. We sought to examine effectiveness of all drugs for preventing MAC infection in adults and children with HIV infection. This review included eight trials conducted in the USA and Europe, published between 1993 and 2003.

We found evidence (very‐low to low grade) that azithromycin or clarithromycin appeared to be a drug of choice for preventing MAC infection. There is a need for further studies to compare direct evidence between clarithromycin and azithromycin and studies to determine the optimal doses required for effective prevention of MAC infection.

Abstract

Background: Mycobacterium avium complex (MAC) infection is a common complication of advanced acquired immunodeficiency syndrome (AIDS) disease and is an independent predictor of mortality and shortened survival.

Objectives: To determine the effectiveness and safety of interventions aimed at preventing MAC infection in adults and children with HIV infection.

Search methods: We searched MEDLINE, EMBASE, and The Cochrane Library (search date December 2012).

Selection criteria: Randomised controlled trials comparing different strategies for preventing MAC infection in HIV‐infected individuals.

Data collection and analysis: Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, a third reviewer resolved conflicts and/or trial authors were contacted for further details. Development of MAC infection and survival were compared using risk ratios (RR) and 95% confidence intervals (CI). The quality of evidence has been assessed using the GRADE methodology.

Main results: Eight studies met the inclusion criteria.

Placebo‐controlled trials

There was no statistically significant difference between clofazimine and no treatment groups in the number of patients that developed MAC infection (RR 1.01; 95% CI 0.37 to 2.80). Rifabutin (one study; RR 0.48; 95% CI 0.35 to 0.67), azithromycin (three studies; RR 0.37; 95% CI 0.19 to 0.74) and clarithromycin (one study; RR 0.35; 95% CI 0.21 to 0.58) were more effective than placebo in preventing the development of MAC infection. There was no statistically significant difference between those treated with clofazimine (one study; RR 0.98; 95% CI 0.41 to 2.32), rifabutin (one study RR 0.91; 95% CI 0.78 to 1.05), azithromycin (three studies, pooled RR 0.96; 95% CI 0.69 to 1.32) and placebo in number of reported deaths. One study found that the risk of death was reduced by 22% in patients treated with clarithromycin compared to those treated with placebo (RR 0.78; 95% CI 0.64 to 0.96).  

Monotherapy vs. monotherapy

Patients treated with clarithromycin (RR 0.60; 95% CI 0.41 to 0.89) and azithromycin (RR 0.60; 95% CI 0.40 to 0.89) were 40% less likely to develop MAC infection than those treated with rifabutin. There was no statistically significant difference between those treated with clarithromycin (RR 0.98; 95% CI 0.83 to 1.15), azithromycin (RR 0.98; 95% CI 0.77 to 1.24) and rifabutin in the number of reported deaths

Combination therapy versus monotherapy

There was no statistically significant difference between patients treated with a combination of rifabutin and clarithromycin and those treated with clarithromycin alone (RR 0.74; 95% CI 0.46 to 1.20); and those treated with combination of rifabutin and azithromycin and those treated with azithromycin alone (RR 0.59; 95% CI 1.03). Patients treated with a combination of rifabutin plus clarithromycin were 56% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.44; 95% CI 0.29 to 0.69). Patients treated with a combination of rifabutin plus azithromycin were 65% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.35; 95% CI 0.21 to 0.59). There was no statistically significant difference in the number of reported deaths in all the four different comparisons of prophylactic agents.

Authors' conclusions: Based on limited data, azithromycin or clarithromycin appeared to be a prophylactic agent of choice for MAC infection. Further studies are needed, especially direct comparison of clarithromycin and azithromycin. In additions, studies that will compare different doses and regimens are needed.

Editorial Group: Cochrane HIV/AIDS Group.

Publication status: Edited (no change to conclusions).

Citation: Uthman MMB, Uthman OA, Yahaya I. Interventions for the prevention of mycobacterium avium complex in adults and children with HIV. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD007191. DOI: 10.1002/14651858.CD007191.pub2. Link to Cochrane Library. [PubMed: 23633339]

Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 23633339

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