Affiliations 

  • 1 Research Institute for Tropical Medicine, Muntinlupa, Philippines
  • 2 The Kirby Institute, UNSW Sydney, Sydney, Australia
  • 3 Queen Elizabeth Hospital, Hong Kong, China
  • 4 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 5 Taipei Veterans General Hospital, Taipei, Taiwan
  • 6 Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia
  • 7 Research Institute for Health Sciences, Chiang Mai, Thailand
  • 8 Bach Mai Hospital, Hanoi, Vietnam
  • 9 Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 10 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 11 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 12 Faculty of Medicine, HIV-NAT/Thai Red Cross AIDS Research Centre, Chulalongkorn University, Bangkok, Thailand
  • 13 National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
  • 14 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 15 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 16 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
  • 17 Institute of Infectious Diseases, Pune, India
  • 18 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 19 Tan Tock Seng Hospital, Singapore
  • 20 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 21 National Center for Global Health and Medicine, Tokyo, Japan
  • 22 TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
J. Acquir. Immune Defic. Syndr., 2019 Apr 01;80(4):436-443.
PMID: 30550488 DOI: 10.1097/QAI.0000000000001933

Abstract

BACKGROUND: Mycobacterium avium complex prophylaxis is recommended for patients with advanced HIV infection. With the decrease in incidence of disseminated Mycobacterium avium complex infection and the availability of antiretroviral therapy (ART), the benefits of macrolide prophylaxis were investigated. This study examined the impact of macrolide prophylaxis on AIDS-defining conditions and HIV-associated mortality in a cohort of HIV-infected patients on ART.

METHODS: Patients from TREAT Asia HIV Observational Database (September 2015 data transfer) aged 18 years and older with a CD4 count <50 cells/mm at ART initiation were included. The effect of macrolide prophylaxis on HIV-associated mortality or AIDS-defining conditions (as a combined outcome) and HIV-associated mortality alone were evaluated using competing risk regression. Sensitivity analysis was conducted in patients with a CD4 <100 cells/mm at ART initiation.

RESULTS: Of 1345 eligible patients, 10.6% received macrolide prophylaxis. The rate of the combined outcome was 7.35 [95% confidence interval (CI): 6.04 to 8.95] per 100 patient-years, whereas the rate of HIV-associated mortality was 3.14 (95% CI: 2.35 to 4.19) per 100 patient-years. Macrolide use was associated with a significantly decreased risk of HIV-associated mortality (hazard ratio 0.10, 95% CI: 0.01 to 0.80, P = 0.031) but not with the combined outcome (hazard ratio 0.86, 95% CI: 0.32 to 2.229, P = 0.764). Sensitivity analyses showed consistent results among patients with a CD4 <100 cells/mm at ART initiation.

CONCLUSIONS: Macrolide prophylaxis is associated with improved survival among Asian HIV-infected patients with low CD4 cell counts and on ART. This study suggests the increased usage and coverage of macrolide prophylaxis among people living with HIV in Asia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.