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Index 
5.7 TB 
5.8 MAI and MAC 
5.9 Hepatitis B and C
Glossary 
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anaemia shortage of oxygen-carrying red blood cells.
antibiotic drug used to treat bacterial infections. Sometimes they work against other kinds of infection.
antibiotic drug used to treat bacterial infections. Sometimes they work against other kinds of infection.
ARV anti-retroviral (drug to treat HIV infection).
bacteria single-cell micro-organisms without a nucleus.
CD4 count number of CD4 cells in a drop of your blood. CD4 counts are measured in cells/mm3.
diagnosis identifying the cause of an illness.
HIV human immunodeficiency virus.
immune system different parts of your body used to fight infections.
latent inactive.
lymphatic system vessel, nodes, organs and clear fluid, that are part of the immune system.
MAI or MAC bacterial infection causing fever, weight loss and weakness.
opportunistic infection (OI) infection that occurs after your immune system has been damaged by HIV.
platelet blood cell that helps with clotting.
prophylaxis treatment to prevent an illness.
pulmonary of the lungs.
resistance when changes in the genetic structure of an organism stops a drug from working.
symptom sign of illness.
thrombocytopenia low platelets.
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Mycobacterium avium and Mycobacterium intracellulare are two bacterial organisms closely related to Mycobacterium tuberculosis which causes TB. Illness from these bacteria is called MAI in Europe and MAC in the US, but they are the same.
If your CD4 count is under 100 cells/mm3 you are at risk for MAI. The lower your CD4 count the higher the risk.
Infection comes from soil, dust or contaminated water, but is not infectious between individuals.
MAI can spread throughout the body, and can affect almost any organ, especially the blood, lymph nodes, liver, spleen and bone marrow. The cells infected by these bacteria include macrophages (white blood cells that engulf infectious material).
In the gut, MAI can cause diarrhoea and abdominal pain because of ulcers.
In the lymphatic system, MAI will cause swollen lymph nodes, liver and spleen.
Blood tests can show low levels of red blood cells (anaemia) and platelets (thrombocytopenia).
MAI is confirmed by growing a culture from blood or samples from the affected part of the body. This can take up to four weeks. An 'acid smear' test is much quicker but cannot tell the difference between MAI and TB.
Treatment involves a combination of 2 or more antibiotics (to reduce the risk of resistance) – usually clarithromycin or azithromycin plus ethambutol.
People who develop resistance to clarithromycin will also have resistance to azithromycin and vice versa. Other drugs used in combinations include rifabutin rifampicin, gentamicin, amikacin, ciprofloxacin and sparfloxacin.
ARV interactions with rifabutin
If ARVs increase CD4 count above 100 cells/mm3 treatment can be safely stopped after 1 year. Otherwise, treatment is life-long.
It is unclear if prophylaxis is needed for people with CD4 counts under 50 cells/mm3. Recommendations vary in different countries.
ARVs are likely to be more protective, as they will increase the CD4 count to a safe level.
Clarithromycin and azithromycin, taken correctly, reduce the risk of MAI by about 70%. But if MAI occurs while taking either of these antibiotics, the infection may be resistant to treatment by both of them.
Prophylaxis for MAI with azithromycin may protect against toxoplasmosis.
Index 5.7 TB 5.8 MAI and MAC 5.9 Hepatitis B and C
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Last updated on Monday 26th November 2007.
