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Previous Volume 329:828-833 September 16, 1993 Number 12 Next

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ABSTRACT

Background Disseminated Mycobacterium avium complex infection eventually develops in most patients with the acquired immunodeficiency syndrome (AIDS). This infection results in substantial morbidity and reduces survival by about six months.

Methods We conducted two randomized, double-blind, multicenter trials of daily prophylactic treatment with either rifabutin (300 mg) or placebo. All the patients had AIDS and CD4 cell counts 200 per cubic millimeter. The primary end point was M. avium complex bacteremia as assessed monthly by blood culture. The secondary end points were signs and symptoms associated with disseminated M. avium complex infection, adverse events, hospitalization, and survival.

Results In the first trial, M. avium complex bacteremia developed in 51 of 298 patients (17 percent) assigned to placebo and 24 of 292 patients (8 percent) assigned to rifabutin (P<0.001). In the second trial, bacteremia developed in 51 of 282 patients in the placebo group (18 percent) and 24 of 274 patients in the rifabutin group (9 percent) (P = 0.002). Rifabutin significantly delayed fatigue, fever, decline in the Karnofsky performance score (by 20 percent), decline in the hemoglobin level (by more than 10 percent), elevation in alkaline phosphatase, and hospitalization. The incidence of adverse events was similar with rifabutin and placebo. Overall survival did not differ significantly between the two groups, although there were fewer deaths with rifabutin (33) than with placebo (47) during the double-blind phase (P = 0.086). The distribution of minimal inhibitory concentrations of rifabutin among the isolates of M. avium complex did not differ significantly between the treatment groups.

Conclusions Rifabutin, given prophylactically, reduces the frequency of disseminated M. avium complex infection in patients with AIDS and CD4 counts 200 per cubic millimeter.

Source Information

From the University of Texas Southwestern Medical Center, Dallas (S.D.N.); Ottawa General Hospital, Ottawa, Ont. (D.W.C.); the Veterans Affairs Medical Center, Washington, D.(F.M.G.); the Veterans Affairs Medical Center, San Francisco (P.M.S.); Public Health Administration and Disease Control, Denver (D.L.C.); Johns Hopkins School of Medicine, Baltimore (R.E.C.); Community Research Initiative of South Florida, Miami (P.D.S.); Community Research Initiative, New York (B.B.); the Pennsylvania Hospital, Philadelphia (J.J.S.); San Diego Community Research Group, San Diego, Calif. (D.D.P.); TheraFirst Medical Center, Fort Lauderdale, Fla. (A.L.); the Long Island Jewish Medical Center, New Hyde Park, N.Y. (F.P.S.); and private practice in Annandale, Va. (L.J.E.), New York (D.L.K.), and Atlanta (W.G.W.). Additional clinical investigators and study centers are listed in the Appendix.

Address reprint requests to Dr. Gordin at the Veterans Affairs Medical Center, 50 Irving St., NW, Washington, DC 20422.

Full Text of this Article

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