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Case 3: Prophylaxis for Mycobacterium avium complex

You answered:

B The patient's CD4 count is less than 50 cells/mm3 and this warrants monthly sputum and stool surveillance cultures for MAC infection. Prophylaxis against disseminated MAC should occur only if the patient has a stool or urine culture positive for MAC.

This answer is incorrect. There are no recommendations to routinely perform surveillance sputum and stool MAC cultures in HIV-infected patients, regardless of their CD4 cell count. The decision to initiate prophylaxis is based on a CD4 cell count less than 50 cells/mm3, not on evidence of MAC in a stool or sputum culture.

Choose another answer:

A The patient's CD4 count is less than 50 cells/mm3 so he should immediately start clarithromycin (Biaxin) plus rifabutin (Mycobutin) for prophylaxis against disseminated MAC.
C Recent guidelines recommend initiating prophylaxis against disseminated MAC in a patient with a CD4 cell count less than 100 cells/mm3 if they have concomitant oral candidiasis.
D The patient's symptoms of weight loss and night sweats suggest he may possibly have disseminated MAC. Before prophylaxis against disseminated MAC is started, disseminated MAC infection should be ruled out.

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