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We describe a patient with acquired immunodeficiency syndrome (AIDS) who developed an infection with Mycobacterium avium complex (MAC) after a successful response to highly active antiretroviral treatment for the human immunodeficiency virus. The onset of this infection occurred when the patient had an undetectable viral load and a CD4⁺ lymphocyte count no longer in the range of what has been considered high risk for MAC (<0.1x10⁹/L [<100/µL]).

A 35-year-old man who had AIDS was hospitalized with Pneumocystis carinii pneumonia. His CD4 T-lymphocyte count was 0.018x10⁹/L and his viral load (determined by quantitative RNA polymerase chain reaction) was 2,582,679 copies/mL. He had consistently declined antiretroviral therapy.

The patient's clinical condition worsened despite treatment with clindamycin, primaquine phosphate, corticosteroids, pentamidine isethionate, empirical ceftriaxone disodium, erythromycin, foscarnet, and granulocyte colony-stimulating factor. Findings from a bronchoscopy sample confirmed P carinii pneumonia and the growth of Enterobacter cloacae. . . . [Full Text of this Article]

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