A Randomized Trial of Prolonged Co-trimoxazole in HIV-Infected Children in Africa

Bwakura-Dangarembizi, Mutsa; Kendall, Lindsay; Bakeera-Kitaka, Sabrina; Nahirya-Ntege, P.; Keishanyu, R.; Nathoo, Kusum; Spyer, Moira; Kekitiinwa, Adeodata; Lutaakome, Joseph; Mhute, Tawanda; Kasirye, Philip; Munderi, Paula; Musiime, Victor; Gibb, Diana; Walker, A. Sarah; Prendergast, Andrew J.

doi:10.1056/nejmoa1214901

Cited by 101 publications

(122 citation statements)

References 35 publications

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“…It is likely that these additional benefits are related to antibacterial, antimalarial and anti‐inflammatory effects. The findings of this trial are therefore less likely to be of relevance in most European settings 30.…”

Section: Prophylaxis Against Opportunistic Infectionsmentioning

confidence: 84%

“…This option is also therefore endorsed by these guidelines. Daily co‐trimoxazole prophylaxis may also be considered for children travelling to countries with a high prevalence of bacterial infections and/or malaria, irrespective of their CD4 count/percentage and current treatment status 6, 24, 30, 31. The use of co‐trimoxazole in this context may also have additional benefit as antimalarial prophylaxis 32, although specific malaria prophylaxis appropriate to the regions being visited should always be prescribed.…”

Section: Prophylaxis Against Opportunistic Infectionsmentioning

confidence: 99%

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Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

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Section: Prophylaxis Against Opportunistic Infectionsmentioning

confidence: 84%

Section: Prophylaxis Against Opportunistic Infectionsmentioning

confidence: 99%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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“…A recently published trial with HIV-infected children receiving long-term ART in sub-Saharan Africa comparing continuing versus stopping co-trimoxazole prophylaxis found that continued co-trimoxazole prophylaxis was beneficial, with fewer hospitalizations and diagnostically confirmed malaria cases (14). Interestingly, fewer cases of other infections and also fewer cases of TB occurred in the continued co-trimoxazole group (5/376 and 15/ 382 TB events in the continued versus stopped co-trimoxazole group, respectively; hazard ratio, 0.33 [95% CI, 0.12 to 0.91]; P ϭ 0.032).…”

Section: Discussionmentioning

confidence: 99%

Co-Trimoxazole Prophylaxis Is Associated with Reduced Risk of Incident Tuberculosis in Participants in the Swiss HIV Cohort Study

Hasse

Walker

Fehr

et al. 2014

Antimicrob Agents Chemother

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h Co-trimoxazole reduces mortality in HIV-infected adults with tuberculosis (TB), and in vitro data suggest potential antimycobacterial activity of co-trimoxazole. We aimed to evaluate whether prophylaxis with co-trimoxazole is associated with a decreased risk of incident TB in Swiss HIV Cohort Study (SHCS) participants. We determined the incidence of TB per 1,000 person-years from January 1992 to December 2012. Rates were analyzed separately in participants with current or no previous antiretroviral treatment (

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“…28 Dangarembizi, dkk. 29 melaporkan bahwa terdapat 17% kejadian efek samping derajat 3 dan 4 pada kelompok yang dihentikan, sementara pada kelompok yang dilanjutkan kejadian efek samping derajat 3 dan 4 adalah 15% dengan rasio hazard 1,20 dan IK 95% 0,83-1,72; p=0,33. Efek samping yang dilaporkan tersebut adalah anemia dan netropenia.…”

Section: Efek Samping Profilaksis Primer Kotrimoksazolunclassified

Gambaran Pemberian Profilaksis Primer Kotrimoksazol pada Pasien HIV Dewasa di Unit Pelayanan Terpadu HIV RSCM Tahun 2004-2013

Mastini¹,

Djoerban²,

Yunihastuti³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Kotrimoksazol diberikan sebagai standar pencegahan primer terhadap infeksi toksoplasmosis dan pneumonia pneumocystis jirovecii (PCP) pada pasien HIV dengan CD4 <200 sel/mm3 dan pasien tuberkulosis, namun penggunaannya masih rendah. Penelitian ini dilakukan untuk mengetahui gambaran pola peresepan profilaksis primer kotrimoksazol pada pasien HIV dewasa di Unit Pelayanan Terpadu HIV RSCM tahun 2004 Metode. Studi kohort r etrospektif dilakukan dengan mengambil data semua pasien HIV usia >18 tahun dan memenuhi kriteria pemberian profilaksis primer kotrimoksazol yang berobat ke Unit Pelayanan Terpadu HIV Rumah Sakir dr. Cipto Mangunkusumo (UPT HIV RSCM) tahun [2004][2005][2006][2007][2008][2009][2010][2011][2012][2013]. Variabel yang diteliti adalah pola inisiasi peresepan, penghentian peresepan, dosis, durasi, persentase lama pemberian, serta ada tidaknya efek samping kotrimoksazol.Hasil. Sejumlah 3.818 pasien mempunyai indikasi pemberian kotrimoksazol. Profilaksis primer kotrimoksazol sudah dimulai pada 83% pasien. Pemberian dosis kotrimoksazol sudah sesuai pedoman pada 99,8% pasien. Efek samping dari yang paling sering sampai yang jarang terjadi adalah peningkatan transaminase (38,1%), leukopenia (16,9%), anemia (16,5%), mual (15,4%), muntah (7,8%), trombositopenia (7,4%), dan alergi (5,3%). Efek samping yang menyebabkan penghentian peresepan adalah alergi (100%), anemia (2,4%), peningkatan transaminase (2,1%), muntah (0,8%), dan leukopenia (0,6%). Ditemukan pola penghentian peresepan yang tidak sesuai pedoman pada 61,6% pasien dengan nilai tengah persentase lama pemberian yaitu 87,5% (RIK 39) dan nilai tengah durasi pemberian profilaksis primer kotrimoksazol adalah 20 bulan (RIK 20). Durasi pada pasien dengan CD4 ≤100 sel/mm3 dan >100 sel/mm 3 masing-masing adalah 21 bulan (RIK 22) dan 12,5 bulan (RIK 14,75) dengan nilai p <0,001.Simpulan. Walaupun pada saat awal sebanyak 83% pasien HIV dewasa mendapat pemberian profilaksis primer kotrimoksazol dengan pengaturan dosis yang sangat baik, namun 61,6% penghentian peresepan tidak sesuai pedoman. (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%), and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%), and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 months (IQR 20). Duration in patients with CD4 ≤100 cell/mm 3 and >100 cell/mm 3 was 21 months (IQR 22) and 12,5 months (IQR 14,75) Kata Kunci: HIV, kotrimoksazol, profilaksis ABSTRACT Introduction. Low rate use of cotrimoxazole which is a standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 <200 cell/mm 3 was found. This study aims to describe prescription pattern of cotrimoxazole primary prophylaxis in adult HIV patients in RSCM. Methods. A cohort r...

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A Randomized Trial of Prolonged Co-trimoxazole in HIV-Infected Children in Africa

Cited by 101 publications

References 35 publications

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Co-Trimoxazole Prophylaxis Is Associated with Reduced Risk of Incident Tuberculosis in Participants in the Swiss HIV Cohort Study

Gambaran Pemberian Profilaksis Primer Kotrimoksazol pada Pasien HIV Dewasa di Unit Pelayanan Terpadu HIV RSCM Tahun 2004-2013

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