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Disseminated MAC Anaemia — SCE Infectious Diseases MCQ

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EasyHIV MedicineDisseminated MAC AnaemiaSCE Infectious Diseases

A 38-year-old man with advanced HIV (CD4 30) presents with chronic diarrhoea, wasting, and a positive blood culture for Mycobacterium avium complex. His ALP is 450 U/L (elevated). CT abdomen shows hepatosplenomegaly and retroperitoneal lymphadenopathy. What haematological abnormality is most commonly associated with disseminated MAC?

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Correct answer: B — Anaemia (often severe, multifactorial — bone marrow infiltration, chronic disease, and ART toxicity)

Disseminated MAC in advanced HIV (CD4 <50) commonly causes anaemia, which can be severe and multifactorial: direct bone marrow infiltration by MAC, anaemia of chronic disease, and potential NRTI-related myelosuppression. Other typical findings include elevated ALP (hepatic infiltration), pancytopenia, hepatosplenomegaly, and constitutional symptoms. Bone marrow biopsy may show granulomata with AFB. Treatment is Clarithromycin (or Azithromycin) plus Ethambutol ± Rifabutin. ART should be started within 2 weeks.

Reference: BHIVA 2022 – OI guidelines; BTS 2017 – NTM