High recurrence rate supports need for secondary prophylaxis in non-HIV patients with disseminated mycobacterium avium complex infection: a multi-center observational study.

Siddharth Sridhar,Kitty S C Fung,Tak-Lun Que,Jasper F W Chan,Alan K L Wu,Ivan F.N Hung,Susanna K P Lau,Jimmy Y W Lam,Eric K T Yip,Patrick C Y Woo

doi:10.1186/s12879-016-1411-8

Abstract

BackgroundLong-term outcomes in non-HIV immunocompromised patients with disseminated Mycobacterium avium complex (dMAC) infections are unknown and the need for post-treatment secondary prophylaxis against MAC is uncertain in this setting. The objective of this study was to determine the need of continuing secondary anti-MAC prophylaxis in non-HIV patients after completing treatment of the primary dMAC episode.MethodsWe conducted a ten-year multi-center analysis of non-HIV immunosuppressed patients with dMAC infections in Hong Kong.ResultsWe observed sixteen patients with dMAC during the study period of which five (31 %) were non-HIV immunosuppressed patients. In the non-HIV immunosuppressed group, three patients completed a treatment course without secondary prophylaxis, one patient received azithromycin-based secondary prophylaxis and one patient was still receiving therapy for the first dMAC episode. All the three patients who completed treatment without being given secondary prophylaxis developed recurrent dMAC infection requiring retreatment.ConclusionsIn view of the high rate of dMAC infection recurrence in non-HIV immunocompromised patients following treatment completion, our data support long-term anti-MAC suppression therapy after treatment of the first dMAC infection episode in immunocompromised non-HIV patients, as is recommended for patients with advanced HIV. Tests of cell mediated immune function need to be evaluated to guide prophylaxis discontinuation in non-HIV patients.

Highlights

Long-term outcomes in non-HIV immunocompromised patients with disseminated Mycobacterium avium complex infections are unknown and the need for post-treatment secondary prophylaxis against MAC is uncertain in this setting
In HIV-positive patients with disseminated Mycobacterium avium complex (dMAC) disease who respond to anti-MAC therapy, current guidelines advise the continuation of anti-MAC treatment as post-treatment suppression until sustained CD4+ T-lymphocyte recovery to >100 cells/μL is achieved using combined antiretroviral therapy [9]
We evaluated the outcomes of non-HIV patients with dMAC infection to determine the need for post-treatment secondary prophylaxis in non-HIV patients, as recommended in the HIV setting

Summary

Introduction

Long-term outcomes in non-HIV immunocompromised patients with disseminated Mycobacterium avium complex (dMAC) infections are unknown and the need for post-treatment secondary prophylaxis against MAC is uncertain in this setting. The need for secondary prophylaxis to prevent dMAC infection recurrence after treatment completion remains a largely unaddressed issue in these patients. This is partly because anti-MAC prophylaxis recommendations for HIV patients are based on CD4+ T-lymphocyte measurements [9, 10] and cannot be applied to non-HIV patients who often suffer from diverse functional cell-mediated immune defects that are not quantified in routine clinical practice. A systematic description of long-term outcomes in non-HIV dMAC infection case cohorts is lacking and the rate of recurrence is unknown

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