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AIDS InfoNet www.aidsinfonet.org Fact Sheet Number 514 MYCOBACTERIUM AVIUM COMPLEX (MAC) WHAT IS MAC? infection is very common but can be CAN MAC BE Mycobacterium Avium Complex (MAC) difficult to diagnose. PREVENTED? is a serious illness caused by common HOW IS MAC TREATED? The bacteria that cause MAC are very bacteria. MAC is also known as MAI The MAC bacteria can mutate and common. It is not possible to avoid (Mycobacterium Avium Intracellulare). develop resistance to some of the being exposed. The best way to MAC infection can be localized (limited drugs used to fight it. Health care prevent MAC is to take strong to one part of your body) or providers use a combination of antiretroviral medications (ARVs). Even disseminated (spread through your antibacterial drugs (antibiotics) to treat if your CD4 cell count drops very low, whole body, sometimes called DMAC). MAC. At least two drugs are used: there are drugs that can stop MAC MAC infection often occurs in the usually azithromycin or clarithromycin disease from developing in up to 50% lungs, intestines, bone marrow, liver, plus up to three other drugs. MAC of people. and spleen. treatment must continue for life, or else the disease will return. The antibiotic drugs azithromycin and The bacteria that cause MAC are very clarithromycin have been used to common. They are found in water, soil, People react differently to anti-MAC prevent MAC. These drugs are usually dust, and food. Almost everyone has drugs. You and your health care prescribed for people with less than 50 them in their body. A healthy immune provider may have to try different CD4 cells. system will control MAC, but people combinations before you find one that with weakened immune systems can works for you with the fewest side Combination antiretroviral therapy can develop MAC disease. effects. make your CD4 cell count go up. If it goes over 100 and stays there for 3 Up to 50% of people with AIDS may The most common MAC drugs and months, it may be safe to stop taking develop MAC, especially if their CD4 their side effects are: medications to prevent MAC. Be sure cell count is below 50. MAC almost  Amikacin (Amkin): kidney and ear to talk with your health care never causes disease in people with problems; taken as an injection. provider before you stop taking any more than 100 CD4 cells.  Azithromycin (Zithromax, see of your prescribed medications. fact sheet 530): nausea, HOW DO I KNOW IF I HAVE headaches, vomiting, diarrhea; DRUG INTERACTION MAC? taken as capsules or intravenously.  Ciprofloxacin (Cipro or Ciloxan, PROBLEMS The symptoms of MAC can include Several drugs used to treat MAC high fevers, chills, diarrhea, weight see fact sheet 531): nausea, vomiting, diarrhea; taken as tablets interact with many other drugs, loss, stomach aches, fatigue, and including ARVs, antifungal drugs, and anemia (low numbers of red blood or intravenously.  Clarithromycin (Biaxin, see fact birth control pills. This is especially true cells). When MAC spreads in the body, for rifampin, rifabutin, and rifapentine. it can cause blood infections, hepatitis, sheet 532): nausea, headaches, vomiting, diarrhea; taken as Be sure your health care provider pneumonia, and other serious knows about all the medications problems. capsules or intravenously. Note: The maximum dose is 500 that you are taking so that all milligrams twice a day. possible interactions can be Many different opportunistic infections considered. can cause these symptoms. Therefore,  Ethambutol (Myambutol): your health care provider will probably nausea, vomiting, vision problems. check your blood, urine, or saliva to  Rifabutin (Mycobutin): rashes, THE BOTTOM LINE look for the bacteria that causes MAC. nausea, anemia. Many drug MAC is a serious disease caused by The sample will be tested to see what interactions. common bacteria. MAC can cause bacteria are growing in it. This process,  Rifampin (Rifampicin, Rifadin, serious weight loss, diarrhea, and other called culturing, can take several Rimactane): fever, chills, muscle or symptoms. weeks. Even if you are infected with bone pain; can turn urine, sweat, MAC, it can be hard to find the MAC and saliva red-orange (may stain If you develop MAC, you will probably bacteria. contact lenses); can interfere with be treated with azithromycin or birth control pills. Many drug clarithromycin plus one to three other If your CD4 cell count is less than 50, interactions. antibiotics. You will have to continue your health care provider might treat taking these drugs for life to avoid a you for MAC, even without a definite recurrence of MAC. diagnosis. This is because MAC

A Project of the International Association of Providers of AIDS Care. Fact Sheets can be downloaded from the Internet at http://www.aidsinfonet.org People with 50 CD4 cells or less should talk with their health care providers about taking drugs to prevent MAC.

Reviewed September 30, 2014

A Project of the International Association of Providers of AIDS Care. Fact Sheets can be downloaded from the Internet at http://www.aidsinfonet.org