Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial

Chintu, Chifumbe; Bhat, GJ; Walker, A. Sarah; Mulenga, Veronica; Sinyinza, Frederick; Lishimpi, Kennedy; Farrelly, Laura; Kaganson, Nicola; Zumla, Alimuddin; Gillespie, SH; Nunn, AJ; Gibb, Diana M

doi:10.1016/s0140-6736(04)17442-4

Cited by 331 publications

(265 citation statements)

References 22 publications

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“…Prophylaxis with co‐trimoxazole is highly effective at preventing potentially life‐threatening infection with P. jirovecii , and also at reducing bacterial infections 24, 25. In view of their susceptibility to severe P. jirovecii infection, all HIV‐infected infants should receive prophylaxis from 4 weeks of age until their first birthday, regardless of CD4 and VL 26.…”

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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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: 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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“…54 In the only randomized controlled study of TMP-SMX prophylaxis in HIV-infected Zambian children, mortality was reduced by 43%, and morbidity, including hospitalization, by 23%. 59 The impact on mortality occurred in children of all ages, suggesting that prophylaxis may also provide protection against bacterial infections. 59…”

Section: Pneumocystis Infectionmentioning

confidence: 99%

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Zar

2007

Pediatric Pulmonology

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The development of chronic lung disease is common in HIV‐infected children. The spectrum of chronic HIV‐associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X‐ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non‐specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV‐infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease. Pediatr Pulmonol. 2008; 43:1–10. © 2007 Wiley‐Liss, Inc.

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“…9.10,14,16 The only RCT done in children was in HIV-infected Zambian children aged 1-14 years, which found a highly signifi cant benefi t of co-trimoxazole in improving survival and reducing hospitalisations and pneumonia (hazard ratio 0·57 [95% CI 0·43-0·77], p=0·0002). 17 Many of the studies showing benefi t have been in communities where in-vitro co-trimoxazole resistance to common bacterial isolates is already high. 14,[16][17][18] It is well recognised that P jirovecii is a common cause of pneumonia and death in HIV-infected infants.…”

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

confidence: 99%

“…17 Many of the studies showing benefi t have been in communities where in-vitro co-trimoxazole resistance to common bacterial isolates is already high. 14,[16][17][18] It is well recognised that P jirovecii is a common cause of pneumonia and death in HIV-infected infants. [19][20][21][22] The introduction of routine co-trimoxazole prophylaxis for infants at risk of HIV infection in several countries has been very eff ective in preventing P jirovecii pneumonia, which could in itself prevent a third to a half of all HIVrelated deaths in African infants.…”

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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Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial

Cited by 331 publications

References 22 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

Chronic lung disease in human immunodeficiency virus (HIV) infected children

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

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