Case 3: Prophylaxis for Mycobacterium avium complex

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You answered:

	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:

	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.
	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.
	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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