Mark Kristoffer U. PasayanMary Lorraine S. MationgDavid BoettigerWilson LamFujie ZhangStephane Wen Wei KuTuti Parwati MeratiRomanee ChaiwarithDo Duy CuongEvy YunihastutiSasisopin KiertiburanakulNguyen Van KinhAnchalee AvihingsanonLy Penh SunAdeeba KamarulzamanPacharee KantipongNagalingeswaran KumarasamySanjay PujariBenedict Lim Heng SimOon Tek NgJun Yong ChoiJunko TanumaJeremy RossRossana A. DitangcoHospital Sungai BulohBeijing Ditan Hospital Capital Medical UniversityVHS Medical Centre IndiaGokilaBach Mai HospitalUniversitas UdayanaUniversity of Indonesia, RSUPN Dr. Cipto MangunkusumoChulalongkorn UniversityKirby InstituteNational Center for Global Health and MedicineYonsei University College of MedicineFaculty of Medicine, Ramathibodi Hospital, Mahidol UniversityQueen Elizabeth Hospital Hong KongUniversity of Malaya Medical CentreVeterans General Hospital-TaipeiTan Tock Seng HospitalNational Hospital for Tropical DiseasesFoundation for AIDS ResearchInstitute of Infectious DiseasesChiangrai Prachanukroh HospitalNational Center for HIV/AIDSResearch Institute for Health Sciences2020-01-272020-01-272019-04-01Journal of Acquired Immune Deficiency Syndromes. Vol.80, No.4 (2019), 436-44310779450152541352-s2.0-85064989723https://repository.li.mahidol.ac.th/handle/20.500.14594/51781© 2018 Wolters Kluwer Health, Inc. All rights reserved. Background:Mycobacterium avium complex prophylaxis is recommended for patients with advanced HIV infection. With the decrease in incidence of disseminated Mycobacterium avium complex infection and the availability of antiretroviral therapy (ART), the benefits of macrolide prophylaxis were investigated. This study examined the impact of macrolide prophylaxis on AIDS-defining conditions and HIV-associated mortality in a cohort of HIV-infected patients on ART.Methods:Patients from TREAT Asia HIV Observational Database (September 2015 data transfer) aged 18 years and older with a CD4 count <50 cells/mm3 at ART initiation were included. The effect of macrolide prophylaxis on HIV-associated mortality or AIDS-defining conditions (as a combined outcome) and HIV-associated mortality alone were evaluated using competing risk regression. Sensitivity analysis was conducted in patients with a CD4 <100 cells/mm3 at ART initiation.Results:Of 1345 eligible patients, 10.6% received macrolide prophylaxis. The rate of the combined outcome was 7.35 [95% confidence interval (CI): 6.04 to 8.95] per 100 patient-years, whereas the rate of HIV-associated mortality was 3.14 (95% CI: 2.35 to 4.19) per 100 patient-years. Macrolide use was associated with a significantly decreased risk of HIV-associated mortality (hazard ratio 0.10, 95% CI: 0.01 to 0.80, P = 0.031) but not with the combined outcome (hazard ratio 0.86, 95% CI: 0.32 to 2.229, P = 0.764). Sensitivity analyses showed consistent results among patients with a CD4 <100 cells/mm3 at ART initiation.Conclusions:Macrolide prophylaxis is associated with improved survival among Asian HIV-infected patients with low CD4 cell counts and on ART. This study suggests the increased usage and coverage of macrolide prophylaxis among people living with HIV in Asia.Mahidol UniversityMedicineArticleSCOPUS10.1097/QAI.0000000000001933