Impact of Cotrimoxazole and Insecticide-Treated Nets for Malaria Prevention on Key Outcomes Among HIV-Infected Adults in Low- and Middle-Income Countries

Abstract

Background HIV-infected adults are at increased risk of severe malaria and death. Malaria prevention in people living with HIV (PLHIV) consists of several interventions, including cotrimoxazole (CTX) prophylaxis and insecticide-treated nets (ITNs). We conducted a systematic review of the available evidence. Methods MEDLINE, EmBase, Global Health, CINAHL, SOCA, and African Index Medicus were used to identify articles relevant to the CTX prophylaxis and ITNs interventions from 1995 to July 2014. For each individual study, we assessed the quality of evidence and the impact of the 2 interventions on the outcomes of mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. For each outcome, we summarized the quality of the overall body of evidence, the expected impact, and costing and cost-effectiveness (CE). Findings The overall quality of evidence regarding malaria-related morbidity was rated as “good” for CTX prophylaxis and “fair” for ITN use; the expected “impact” of these interventions on morbidity was rated “high” and “uncertain,” respectively. Three studies that addressed the costing and CE of ITN provision for malaria prevention in PLHIV consisted of 2 full “level 1” and 1 partial “level 2” economic evaluations. Conclusions CTX prophylaxis is effective in reducing malaria-related morbidity among PLHIV. Limited evidence is available with respect to the impact and the CE of ITN use and/or provision in this population.

HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease

“…Real-world considerations are relevant when TMP-SMX is evaluated as a preferred treatment for cerebral toxoplasmosis. Potential advantages of TMP-SMX over P-S or P-C include (1) the convenience of the lower pill burden and dosing frequency and the availability of intravenous formulations; current guidelines suggest the option of intravenous TMP-SMX as initial treatment in severely ill patients 98 ; (2) the availability of several generic TMP-SMX formulations with the consequent impact on cost-effectiveness and increased accessibility; (3) prevention of Pneumocystis jirovecii pneumonia, other bacterial infections, and malaria 98,176 ; and (4) the convenience of use simplifying the early initiation of cART, which is associated with increased survival of HIV-infected patients with most opportunistic diseases.…”

A systematic review and meta‐analysis of the relative efficacy and safety of treatment regimens for HIV‐associated cerebral toxoplasmosis: is trimethoprim‐sulfamethoxazole a real option?

“…Currently, potential advantages of TMP‐SMX over P‐S or P‐C include: the convenience of the lower pill burden and dosing frequency and the availability of intravenous formulations; current guidelines suggest an option of parenteral TMP‐SMX usage as initial treatment in severely ill patients ; the availability of several generic TMP‐SMX formulations with the consequent impact on cost‐effectiveness and increased accessibility; prevention of Pneumocystis jirovecii pneumonia, other bacterial infections, and malaria ; and the convenience of use simplifying the early initiation of HAART, which is associated with increased survival of HIV‐infected patients with most opportunistic diseases.…”