How do I manage disseminated Mycobacterium avium complex disease in people with HIV?

IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Clinical Microbiology and Infection Pub Date : 2024-08-30 DOI:10.1016/j.cmi.2024.08.022
Tommaso Matucci, Giacomo Pozza, Angelo Roberto Raccagni, Alberto Borghetti, Silvia Nozza, Andrea Giacomelli, Niccolò Riccardi
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Abstract

Background: Advanced HIV disease (AHD) is increasing, with late presentation accounting for half of newly diagnosed people with HIV (PWH) in Europe. Mortality in late-presenting PWH remains high, and Mycobacterium avium complex (MAC) disease, among other opportunistic infections, presents several diagnostic and treatment challenges that lead, ultimately, to a poor clinical outcome.

Objectives: We aimed to provide guidance on the diagnosis and treatment of disseminated MAC disease (dMACd) in PWH.

Sources: We performed a review of original articles, meta-analyses, and systematic reviews retrieved from PubMed.

Content: We reviewed and discussed the most challenging steps in the management of PWH with AHD and dMACd: the current epidemiology in the era of effective antiretroviral treatment; clinical presentation and interpretation of symptoms in the context of other opportunistic infections and immune reconstitution; diagnosis, sampling, and timing to reach a definitive diagnosis; prophylaxis, treatment options, and indications for discontinuing MAC treatment; future perspectives; and the role of rifamycins in the treatment of dMACd.

Implications: Despite the widespread availability of effective antiretroviral treatment, dMACd still represents a major cause of morbidity and mortality in PWH with AHD. Residual challenges are mainly related to the difficulties and timing required to reach a definitive diagnosis, and the discussion regarding the role of rifamycins in the treatment of dMACd is still open.

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"如何管理艾滋病毒感染者的播散性复合分枝杆菌(MAC)疾病?
背景:晚期艾滋病毒疾病(AHD)正在增加,在欧洲,新确诊的艾滋病毒感染者(PWH)中有一半是晚期患者。晚期艾滋病病毒感染者的死亡率仍然很高,而复合分枝杆菌病(MAC)与其他机会性感染一样,给诊断和治疗带来了诸多挑战,最终导致不良的临床结果:我们旨在为诊断和治疗 PWH 中的播散性 MAC 病(dMACd)提供指导:我们对从 PubMed 上检索到的原创文章、荟萃分析和系统综述进行了综述:内容:我们回顾并讨论了对患有AHD和dMACd的PWH进行管理的最具挑战性的步骤:在有效的抗逆转录病毒治疗(ART)时代的当前流行病学;临床表现以及在其他机会性感染和免疫重建背景下对症状的解释;诊断、取样和达到明确诊断的时机;预防、治疗选择以及停止MAC治疗的指征;未来展望以及利福霉素在治疗dMACd中的作用:意义:尽管有效的抗逆转录病毒疗法已得到广泛应用,但在患有艾滋病的残疾人中,麦角疯仍是发病和死亡的主要原因。余下的挑战主要与明确诊断所需的困难和时间有关,而关于利福霉素在治疗dMACd中的作用的讨论仍未结束。
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来源期刊
CiteScore
25.30
自引率
2.10%
发文量
441
审稿时长
2-4 weeks
期刊介绍: Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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