Patients with
AIDS and disseminated Mycobacterium avium complex (MAC)
infection can have progressive disease despite combination antimycobacterial
therapy. Our goal was to determine the utility of
corticosteroids as adjunctive
therapy for
AIDS patients with disseminated MAC
infection and refractory symptoms despite combination antimycobacterial
therapy. We retrospectively reviewed 12 consecutive patients whose
therapy for MAC
infection clinically failed and who subsequently received low-dose oral
corticosteroids in addition to continued combination antimycobacterial
therapy. With the addition of
corticosteroids, 11 of 12 patients experienced a rapid improvement in symptoms, with diminished or resolved
fevers and night sweats, and an increased sense of well-being and energy. Ten of 12 patients gained weight; the differences between weights before and after
steroid therapy were statistically significant (P = .003, paired Student's t-test), and the weights achieved were similar to baseline weights prior to the development of MAC
infection (
P = .2). Mean survival after diagnosis of MAC
infection was 17.5 months. New opportunistic processes developed in seven patients during
corticosteroid therapy. However, given the severely immunocompromised status of these patients, it was not possible to attribute the development of new opportunistic processes directly to
corticosteroid therapy.