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Case 4: A 32-Year-Old with Fever, Weight Loss, and Fatigue

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C The 2002 U.S. Public Health Service 2002 Guidelines for Preventing Opportunistic Infections state that secondary prophylaxis (to prevent recurrence of disseminated MAC) may be discontinued in patients treated with HAART who have a sustained (greater than 6 months) increase in CD4 count to greater than 100 cells/mm3 if they have completed 12 months of MAC therapy and have no ongoing symptoms or signs attributable to MAC.

This answer is correct. Several studies have shown that patients who have been treated for disseminated MAC and have a sustained response to HAART are unlikely to develop recurrent disseminated MAC if they discontinue maintenance therapy for MAC. These studies led to the recommendation in the 2002 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections that secondary prophylaxis for MAC may be discontinued in patients treated with HAART who have a sustained (greater than 6 months) increase in CD4 count to greater than 100 cells/mm3 if they have completed 12 months of MAC therapy and have no ongoing symptoms or signs attributable to MAC.

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