Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d'Ivoire: a randomised controlled trial

Wiktor, Stefan Z.; Sassan-Morokro, Madeleine; Grant, Alison D.; Abouya, L.; Karon, John M.; Maurice, Chantal; Djomand, Gaston; Ackah, Alain; Domoua, K.; Kadio, A.; Yapi, A.; Combe, P; Tossou, Odette; Roels, Thierry H.; Lackritz, Eve; Coulibaly, Daouda; Cock, Kevin M. De; Coulibaly, Issa-Malick; Greenberg, Alan E.

doi:10.1016/s0140-6736(99)03465-0

Cited by 369 publications

(265 citation statements)

References 29 publications

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“…11 The effects on morbidity and mortality are similar to those found in other studies in Africa. [3][4][5][6][7] Some of the beneficial effect of co-trimoxazole could be the result of a stabilisation of immune status. By directly preventing some opportunistic infections, co-trimoxazole might have led to reductions in the frequency of episodes of increased HIV viral load associated with acute illness, [12][13][14][15] resulting in improved long-term CD4-cell response.…”

Section: Discussionmentioning

confidence: 99%

“…1 It has been recommended for use in Africa on the basis of lower morbidity and mortality among people with HIV infection and AIDS, [2][3][4][5][6][7] but it is rarely used. 8 Questions remain about the efficacy of cotrimoxazole in areas of high bacterial resistance, its relative usefulness among individuals with differing CD4-cell counts, and the mechanisms through which it exerts its effect.…”

Section: Introductionmentioning

confidence: 99%

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Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

et al. 2004

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SummaryBackground Prophylaxis with co-trimoxazole (trimethoprim-sulphamethoxazole) is recommended for people with HIV infection or AIDS but is rarely used in Africa. We assessed the effect of such prophylaxis on morbidity, mortality, CD4-cell count, and viral load among people with HIV infection living in rural Uganda, an area with high rates of bacterial resistance to co-trimoxazole.Methods Between April, 2001, and March, 2003, we enrolled, and followed up with weekly home visits, 509 individuals with HIV-1 infection and their 1522 HIV-negative household members. After 5 months of follow-up, HIV-positive participants were offered daily co-trimoxazole prophylaxis (800 mg trimethoprim, 160 mg sulphamethoxazole) and followed up for a further 1·5 years. We assessed rates of malaria, diarrhoea, hospital admission, and death. Findings Co-trimoxazole was well tolerated with rare (<2% per person-year) adverse reactions. Even though rates of resistance in diarrhoeal pathogens were high (76%), co-trimoxazole prophylaxis was associated with a 46% reduction in mortality (hazard ratio 0·54 [95% CI 0·35-0·84], p=0·006) and lower rates of malaria (multivariate incidence rate ratio 0·28 [0·19-0·40], p<0·0001), diarrhoea (0·65 [0·53-0·81], p<0·0001), and hospital admission (0·69 [0·48-0·98], p=0·04). The annual rate of decline in CD4-cell count was less during prophylaxis than before (77 vs 203 cells per µL, p<0·0001), and the annual rate of increase in viral load was lower (0·08 vs 0·90 log 10 copies per mL, p=0·01).Interpretation Daily co-trimoxazole prophylaxis was associated with reduced morbidity and mortality and had beneficial effects on CD4-cell count and viral load. Co-trimoxazole prophylaxis is a readily available, effective intervention for people with HIV infection in Africa.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

et al. 2004

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“…It has a broad-spectrum prophylactic action against common bacterial pathogens, Pneumocystis jirovecii (formerly Pneumocystis carinii) , and protozoa such as Plasmodium spp and Isospora belli. Randomised controlled trials (RCTs) 9,10 and studies with historical controls [11][12][13][14][15][16] in HIVinfected African adults consistently show signifi cant benefi ts in survival for those receiving co-trimoxazole prophylaxis. These improvements in survival have been accompanied by substantial reductions of severe disease events and the number of hospital admissions linked to invasive bacterial disease, pneumonia, malaria, and diarrhoea, although disease-specifi c benefi t has varied between studies.…”

Section: Benefi Ts Of Co-trimoxazole Prophylaxis In Hivinfected Infanmentioning

confidence: 99%

Scaling-up co-trimoxazole prophylaxis in HIV-exposed and HIV-infected children in high HIV-prevalence countries

Zachariah

Harries

Luo

et al. 2007

The Lancet Infectious Diseases

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Co-trimoxazole (trimethoprim-sulfamethoxazole) is a widely available antibiotic that substantially reduces HIV-related morbidity and mortality in both adults and children. Prophylaxis with co-trimoxazole is a recommended intervention of proven benefi t that could serve not only as an initial step towards improving paediatric care in young children with limited access to antiretroviral treatment, but also as an important complement to antiretroviral therapy in resourcelimited settings. Despite co-trimoxazole's known clinical benefi ts, the potential operational benefi ts, and favourable recommendations by WHO, UNAIDS, and UNICEF, its routine use in developing countries-particularly subSaharan Africa-has remained limited. Out of an estimated 4 million children in need of co-trimoxazole prophylaxis (HIV-exposed and HIV-infected), only 4% are currently receiving this intervention. We discuss some of the major barriers preventing the scale-up of co-trimoxazole prophylaxis for children in countries with a high prevalence of HIV and propose specifi c actions required to tackle these challenges.

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“…Some clinicians cite the risk of developing cotrimoxazole resistance, cost to the patient, and excessive pill burden as reasons for using the CD4 count or TLC for determining prophylaxis in patients with TB [16].…”

Section: Tlc In Patients With Tuberculosismentioning

confidence: 99%

Total lymphocyte count as a tool for timing opportunistic infection prophylaxis in resource-limited settings: a study from India

Srirangaraj¹,

Venkatesha

2010

J Infect Dev Ctries

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Introduction: In resource-limited settings, due to the high cost of CD4 cell count testing, physicians must decide about opportunistic infection (OI) prophylaxis without a laboratory evaluation of HIV stage and level of immune suppression. This study aimed to evaluate the correlation of total lymphocyte count (TLC), an inexpensive laboratory parameter, to CD4 count, and to determine a range of TLC cut-offs for the initiation of OI prophylaxis that is appropriate for resource-limited settings. Methodology: Spearman correlation between CD4 count and TLC was assessed in patients attending the Anti-Retroviral Therapy (ART) centre at Mysore, India. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of various TLC cut-offs were computed for CD4 counts < 200 cells/mm 3 . Correlation and statistical indices were computed for all patients and for HIV patients with active tuberculosis. Results: Good correlation was noted between the 106 paired TLC and CD4 counts (r = 0.3497).TLC < 1200cells/mm 3 had 88.14% sensitivity and 34.78% specificity for CD4 count < 200 cells/mm 3 . In those patients with active tuberculosis, TLC< 2000cells/mm 3 had 95.24% sensitivity and 100% specificity for CD4 count < 200cells/ mm 3 . Conclusions: TLC could serve as a low-cost tool for determining when to initiate prophylaxis in resource-constrained settings.

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Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d'Ivoire: a randomised controlled trial

Cited by 369 publications

References 29 publications

Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

Scaling-up co-trimoxazole prophylaxis in HIV-exposed and HIV-infected children in high HIV-prevalence countries

Total lymphocyte count as a tool for timing opportunistic infection prophylaxis in resource-limited settings: a study from India

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