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Disseminated MAC ART Timing — SCE Infectious Diseases MCQ

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ModerateHIV MedicineDisseminated MAC ART TimingSCE Infectious Diseases

A 42-year-old man with advanced HIV (CD4 20) not on ART presents with disseminated Mycobacterium avium complex. Blood cultures grow MAC. He is started on Clarithromycin plus Ethambutol. When should ART be started?

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Correct answer: D — Within 2 weeks of starting MAC treatment

For disseminated MAC in advanced HIV, ART should be started within 2 weeks of initiating MAC treatment. Unlike TB meningitis (where early ART may cause excess adverse events), early ART in disseminated MAC is associated with improved survival. The risk of MAC-IRIS (paradoxical worsening after immune reconstitution) exists but is generally manageable. If MAC is the only OI and CD4 is very low, the benefit of early ART outweighs the IRIS risk.

Reference: BHIVA 2022 – OI guidelines; WHO 2022 – ART timing with OIs