Mycobacterium avium complex (MAC) is a group of bacteria related to tuberculosis. These germs are very common in food, water, and soil. Almost everyone has them in their bodies. When you have a strong immune system, they don't cause problems. But they can make people with weaker immune systems, like those with HIV, very sick.
Because of that, it's considered an opportunistic infection. MAC usually causes problems after HIV becomes AIDS and your CD4 cell count gets lower than 50.
You can prevent MAC by starting antiretroviral therapy (ART) early and not allow your CD4 count to get low. If you have a low CD4 count and you get MAC, the infection can be treated, but you may need to take MAC drugs for a long time, until your CD4 count increases in response to ART.
Symptoms
It can infect one part of your body, like your lungs, bones, or intestines. This is localized infection. It can also spread and cause disease throughout your body. Your doctor may call that disseminated infection.
If MAC goes all over your body, you may have:
- High fever or chills
- Night sweats
- Belly pain
- Diarrhea
- Weight loss
- Fatigue
- Swollen glands
- Fewer red blood cells (anemia)
You could also have serious symptoms like:
Getting a Diagnosis
Many other infections can cause the same symptoms as MAC. Getting the right diagnosis will help you treat it.
In addition to a physical exam, your doctor may order lab tests to find MAC bacteria in your:
The samples your doctor will take will grow for several weeks in a lab. Then a lab technician will check these cultures for signs of MAC.
While waiting for those results, your doctor may order other tests, including blood tests to check for problems such as anemia and liver disease.
A CT scan of your chest and abdomen can help your doctor see problems with your lymph nodes, liver, or spleen.
Your doctor may also take a tissue sample and look it under a microscope. That's called a biopsy.
Treatment
In addition to starting ART, to fight MAC you'll probably get a combination of antibiotics so your body doesn't become resistant to any one drug. You will likely get either azithromycin (Zithromax) or clarithromycin (Biaxin) plus ethambutol (Myambutol). Depending on the severity of your infection and your immune status, additional antibiotics that might be needed include:
- Amikacin (Amikin)
- Moxifloxacin (Avelox)
- Rifabutin (Mycobutin)
- Rifampin (Rifampicin, Rifadin, or Rimactane)
After you get the infection under control, you'll switch to maintenance treatment for about 12 months. This treatment generally consists of the same drugs in your initial treatment.
MAC medications can have side effects, such as:
- Feeling queasy, throwing up, or diarrhea
- Abdominal pain
- Eye swelling that brings eye pain, light sensitivity, redness, or blurred vision
- Rashes, itching
- Anemia
- Hearing Loss
- Numbness in feet
- Hearing loss
- Headache
MAC drugs may also cause problems with:
- Antifungal medications
- Birth control pills
- Blood-thinning drugs
Prevention
Because MAC bacteria are so common, it's not really possible to avoid them. Instead, the best way to prevent MAC when you have HIV is to take ART. If you have a low CD4 count, additional drugs to prevent MAC are no longer recommended if you are taking ART that is expected to make the HIV virus in your blood “undetectable.”
If you have a low CD4 count and you get MAC, in addition to your ART you will need to take your MAC medication until your CD4 count increases in response to ART. If you can keep your CD4 count above 100 for 6 months while on ART, you may be able to stop taking medicine for MAC. But you'll need to start again if your CD4 count goes back down.
