British HIV Association guidelines on the management of opportunistic infection in people living with HIV:
The clinical management of non-tuberculous mycobacteria 2023
A wide spectrum of non-tuberculous mycobacteria (NTM) has been reported as isolates from or causes of disease in people living with human immunodeficiency virus (HIV). This is typically in the context of very advanced immunosuppression in the absence of virological suppression with combination antiretroviral therapy (ART) and most individuals have presented with disseminated disease.
NTM are environmental organisms. Therefore it is important to determine, prior to treatment initiation, whether the organism is the cause of the disease process rather than a reflection of subsequent colonisation. With the exception of Mycobacterium avium complex (MAC), there is limited evidence to guide the choice or duration of treatment and expert opinion should be sought from a clinician experienced in managing mycobacterial disease in the context of HIV. Also with the exception of MAC, most of the recommendations for the treatment of NTM have been extrapolated from trials of treatment for NTM pulmonary disease in individuals without HIV although some evidence from early trials in populations with advanced HIV disease has added to this guidance.
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