Prevention of
opportunistic infections is an integral part of caring for patients infected with human immunodeficiency virus. Mycobacterium avium complex (MAC)
bacteremia can cause severe morbidity and excess mortality among these patients. Controlled trials of
rifabutin for the prophylaxis of MAC
bacteremia have been completed.
Rifabutin reduced the incidence of MAC
bacteremia by approximately one-half and, when disseminated disease due to MAC (DMAC) did develop, reduced the frequency of associated clinical symptoms. Moreover, prophylaxis with
rifabutin was well tolerated. Prophylaxis of MAC
bacteremia with
macrolide antibiotics is currently being investigated, but no data from large-scale prospective trials are yet available. On the basis of trials completed thus far, the U.S. Public Health Service has recently recommended the use of
rifabutin (300 mg/d) as prophylaxis for MAC
bacteremia in patients with fewer than 100 CD4+ lymphocytes/mm3. The widespread use of this prophylactic regimen could reduce the rates of morbidity and mortality caused by DMAC. However,
rifabutin must be administered only after careful consideration of the circumstances of individual patients. Potential drug interactions, cost, and compliance are important factors in the decision about which patients should receive prophylaxis.