Case 3: Prophylaxis for Mycobacterium avium complex

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You answered:

	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.

This answer is incorrect. Current guidelines for the prevention of opportunistic infections recommend that patients who have a CD4 cell count less than 50 cells/mm³ should initiate prophylaxis against disseminated MAC disease. The presence or absence of oral candidiasis is not a factor in deciding whether to initiate MAC prophylaxis.

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.
	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.
	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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