Mycobacterium avium Complex (MAC)

November 2004     View PDF     En español

Stopping preventive therapy

Many studies have shown that OIs and deaths have been reduced since protease inhibitors were first used. Now several studies show that it may be safe for people on potent anti-HIV therapy to stop OI prevention if there is evidence of immune reconstitution.

One study looked at 643 people whose CD4+ cell count had risen from below 50 to over 100 following potent anti-HIV therapy. About 60% of people in the study had viral loads below 500 copies HIV RNA. They were given either azithromycin (1,200mg once a week) or placebo (sugar pill).

After one year there were only two cases of MAC, and both cases were in the placebo group. So, people who have had a CD4+ cell count over100 and a low viral load for at least three to six months may be able to stop taking MAC prevention. You should think about restarting MAC prevention if your CD4+ cell count falls back below 50.

When making a decision about OI prevention, consider these guidelines:

• Potent anti-HIV therapy restores the immune response slowly over time. It may be wise to wait until you establish a good response to anti-HIV therapy (HIV levels decrease and CD4+ cell counts increase) for at least a few months before changing prevention strategies.
• The risk of stopping prevention is likely to be lowest in people who have never had an OI before they started anti-HIV therapy.
• People who have the strongest and longest-lasting improvement in CD4+ cell count due to anti-HIV therapy probably stand the best chance of success when stopping OI prevention.
• A person’s tolerance for the risk of getting an OI must be weighed against their willingness to take extra drugs and risk side effects.