Adjunctive corticosteroid therapy for patients whose treatment for disseminated Mycobacterium avium complex infection has failed

Abstract

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.