In which situation is no prevention required for Mycobacterium avium complex (MAC)?

The assertion that prevention for Mycobacterium avium complex (MAC) is not required when the patient is not on HIV treatment is not accurate. In fact, the need for prevention of MAC is closely related to the patient's immune status, specifically the CD4 cell count.

Individuals with HIV who have a CD4 count above 100 cells/mm³ typically do not require MAC prophylaxis, as their immune system is strong enough to fend off opportunistic infections like MAC. This makes a high CD4 count a crucial factor in determining the need for prevention.

Additionally, while being asymptomatic can indicate a lower level of disease progression, it does not directly correlate with the risk of MAC in the absence of treatment or a sufficiently high CD4 count. Prophylactic treatment is crucial for immunocompromised individuals to prevent infections, particularly when their CD4 counts fall below 100 cells/mm³, hence offering context to the importance of immune status and treatment in assessing the risk of MAC.