Primary Prevention With Cotrimoxazole for HIV-1???Infected Adults: Results of the Pilot Study in Dakar, Senegal

Maynart, Maryvonne; Lièvre, Laurence; Sow, Papa Salif; Kony, Sabine; Gueye, Ndèye Fatou Ngom; Basséne, Emmanuel; Metro, A.; Ndoye, Ibra; Ba, Diouana Sira; Coulaud, J. P.; Costagliola, Dominique

doi:10.1097/00042560-200102010-00004

Cited by 20 publications

(20 citation statements)

References 19 publications

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“…21,23,24 Although we found relatively high rates of PCP with CD4 counts of 50 cells/KL or less, there was a nonsignificant trend toward a lower rate in blacks. 21,25 It is also possible that delays in PCP diagnosis, while ruling out TB and treating empirically for bacterial disease, may have underestimated the incidence rate with CD4 counts of more than 50 cells/KL. The results of this study suggest that targeted prophylaxis could have a large impact on reducing OIs, the reduction of which may be a key to reducing long-term mortality in HIV-infected patients.…”

Section: Discussionmentioning

confidence: 99%

CD4 Decline and Incidence of Opportunistic Infections in Cape Town, South Africa

Holmes

Wood

Badri

et al. 2006

JAIDS Journal of Acquired Immune Deficiency Syndromes

155

146

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Section: Discussionmentioning

confidence: 99%

CD4 Decline and Incidence of Opportunistic Infections in Cape Town, South Africa

Holmes

Wood

Badri

et al. 2006

JAIDS Journal of Acquired Immune Deficiency Syndromes

155

146

View full text Add to dashboard Cite

show abstract

“…Subsequently, a small randomised clinical trial from Senegal was stopped early (because of the announcement of the WHO/UNAIDS recommendations 6 ); the authors concluded that chemoprophylaxis with low dose co-trimoxazole did not show a beneficial effect on survival or the occurrence of opportunistic or nonopportunistic infections. 7 The levels of resistance of locally relevant pathogens to co-trimoxazole was low in the Côte d'Ivoire studies, whereas much higher rates have been reported elsewhere. [8][9][10][11][12] Zambia has no policy on co-trimoxazole prophylaxis in people with HIV infection.…”

Section: Introductionmentioning

confidence: 87%

Role of co-trimoxazole prophylaxis in reducing mortality in HIV infected adults being treated for tuberculosis: randomised clinical trial

Nunn

Mwaba

Chintu

et al. 2008

BMJ

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Objective To assess the impact of prophylactic oral cotrimoxazole in reducing mortality in HIV positive Zambian adults being treated for pulmonary tuberculosis. Design Double blind placebo controlled randomised clinical trial. Participants Two groups of antiretroviral treatment naive adults with HIV infection: patients newly diagnosed as having tuberculosis and receiving tuberculosis treatment either for the first time or for retreatment after relapse; previously treated patients not receiving treatment. Intervention Oral co-trimoxazole or matching placebo daily. Primary outcome measures Time to death and occurrence of serious adverse events related to study drug. Results 1003 patients were randomised: 835 (416 cotrimoxazole, 419 placebo) were receiving treatment for tuberculosis, 762 (376 co-trimoxazole, 386 placebo) of them newly diagnosed previously untreated patients and 73 (40 co-trimoxazole, 33 placebo) receiving a retreatment regimen; 168 (84 co-trimoxazole, 84 placebo) were not on treatment but had received treatment in the past. Of 835 participants receiving tuberculosis treatment, follow-up information was available for 757, with a total of 1012.6 person years of follow-up. A total of 310 (147 co-trimoxazole, 163 placebo) participants died, corresponding to death rates of 27.3 and 34.4 per 100 person years. In the Cox regression analysis, the hazard ratio for death (co-trimoxazole:placebo) was 0.79 (95% confidence interval 0.63 to 0.99). The effect of cotrimoxazole waned with time, possibly owing to falling adherence levels; in a per protocol analysis based on patients who spent at least 90% of their time at risk supplied with study drug, the hazard ratio was 0.65 (0.45 to 0.93). Conclusions Prophylaxis with co-trimoxazole reduces mortality in HIV infected adults with pulmonary tuberculosis. Co-trimoxazole was generally safe and well tolerated. Trial registration Current Controlled Trials ISRCTN15281875.

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“…cause morbidity and mortality in African populations, suggesting wider benefits that possibly resulted from activity against various parasitic, fungal, and bacterial infections [2][3][4][5]. HIV/AIDS treatment guidelines recommend cotrimoxazole as a component of care for adults (including pregnant women) with low CD4 cell counts [6].…”

mentioning

confidence: 99%

Reduction in Preterm Delivery and Neonatal Mortality after the Introduction of Antenatal Cotrimoxazole Prophylaxis among HIV‐Infected Women with Low CD4 Cell Counts

et al. 2006

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Among 255 women with CD4 cell counts <200 cells/ micro L, the percentage of preterm births (< or =34 weeks of gestation) was lower (odds ratio [OR], 0.49 [95% confidence interval {CI}, 0.24-0.98]) after cotrimoxazole prophylaxis was introduced than before; there was a significant decrease in neonatal mortality (9% to 0%; P=.01) and a trend toward increased birth weight ( beta =114 g [95% CI, -42 to 271 g]). In contrast, there were no significant changes in these parameters over the same time interval among women with CD4 cell counts > or =200 cells/ micro L.Conclusion. Antenatal provision of cotrimoxazole for HIV-infected pregnant women with low CD4 cell counts may have indirect benefits for neonatal health.

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Primary Prevention With Cotrimoxazole for HIV-1???Infected Adults: Results of the Pilot Study in Dakar, Senegal

Abstract: Our study does not show a beneficial effect of chemoprophylaxis with low-dose cotrimoxazole on survival or occurrence of opportunistic or nonopportunistic infections for HIV-1-infected patients in Dakar, Senegal.

Cited by 20 publications

References 19 publications

CD4 Decline and Incidence of Opportunistic Infections in Cape Town, South Africa

CD4 Decline and Incidence of Opportunistic Infections in Cape Town, South Africa

Role of co-trimoxazole prophylaxis in reducing mortality in HIV infected adults being treated for tuberculosis: randomised clinical trial

Reduction in Preterm Delivery and Neonatal Mortality after the Introduction of Antenatal Cotrimoxazole Prophylaxis among HIV‐Infected Women with Low CD4 Cell Counts

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