Treatment of disseminated mycobacteriosis caused by Mycobacterium avium in HIV patients using bedaquiline: clinical examples

Abstract

Three clinical cases of treatment of patients with disseminated mycobacteriosis caused by M. avium using the drug bedaquilin have been described. The criteria for prescribing bedaquiline were M. avium resistance to two drugs in the regimen (primarily to clarithromycin) and/or adverse events leading to drug withdrawal. Regimen of the bedaquiline administration: 400 mg once daily for the first 14 days, from day 15 until the end of the course of therapy – 200 mg 3 times a week. The main criteria for treatment efficacy were: normalization of temperature, relief of clinical manifestations, cessation of isolation of nontuberculous mycobacteria. All patients had involvement of the intra-abdominal lymph nodes, lungs, and intestines. There was also involvement of the intrathoracic lymph nodes, peripheral lymph nodes, and bone marrow. Duration of the bedaquiline therapy ranged from 14 to 17 months and depended on the timing of the cessation of bacterial excretion. During the bedaquiline therapy there was no adverse events that required discontinuation of the drug. Upon completion of therapy no relapses were recorded during 2 years observation. We conclude, that use of bedaquiline in the treatment regimens of disseminated mycobacteriosis caused by M. avium in HIV-infected patients helped to stabilize the condition, the cessation of bacterial excretion and improve immunological parameters, including an increase in CD4 T-lymphocyte count. The results obtained require further study of the use of bedaquiline in this category of patients.