The Body Covers: The 7th Conference on Retroviruses and Opportunistic Infections
Pathogenesis and Treatment of Mycobacterial Infections
January 31, 2000
This protocol looks at the diagnostic value of MAC culture from different sites in patients with symptoms clinically suggestive of MAC infection. Importantly, 80% of patients clinically suggestive of MAC had no positive culture. Of those with positive cultures, the bone marrow was the most sensitive: only 1/4 patients with a positive bone marrow culture had a positive blood culture. Cultures from non-sterile sites had little prognostic value. Additional analysis demonstrated that those with positive cultures had lower measures of immune responsiveness.
In those with suspected MAC infection, treatment should not be dependent on positive culture results. Bone marrow culture may have the highest yield of various culture sites.
HIV treatment dramatically reduced the risk of developing active tuberculosis: the relative risk for those on a two drug regimen was 18% of those on no treatment, and less than 10% for those on three drugs (relative risk adjusted for T cells and skin test status).
Even in those at high risk for development of TB, treatment of concurrent HIV infection can dramatically reduce the incidence of active TB.
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