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MAC vs Whipple Histology — SCE Infectious Diseases MCQ

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HardHIV MedicineMAC vs Whipple HistologySCE Infectious Diseases

After microbiologically confirmed disseminated MAC is treated and ART is started, fever and lymph-node enlargement recur as HIV viraemia falls. Cultures remain negative. Which interpretation and response best fit?

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Correct answer: E — Continue effective MAC therapy and ART, exclude relapse or another diagnosis, and treat clinically important IRIS through specialist review

The best answer is “Continue effective MAC therapy and ART, exclude relapse or another diagnosis, and treat clinically important IRIS through specialist review”. The temporal relationship to immune recovery, falling viraemia and sterile cultures supports MAC-associated immune reconstitution inflammatory syndrome after competing diagnoses and microbiological relapse have been assessed. Effective MAC treatment and ART usually continue; clinically important inflammation may require specialist-directed corticosteroid treatment. Escalating or replacing antimicrobials without evidence of failure, permanently stopping ART, or ending MAC therapy would expose the patient to avoidable resistance or relapse.

Reference: BHIVA opportunistic-infection guidelines: https://bhiva.org/clinical-guideline/oi-guidelines/