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

Abstract

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.

Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme

“…50% of those off ART and 90% of those on ART) did not meet guideline recommendations, 23 useful information has been collected for sub-Saharan Africa, where data are generally lacking. 22,24 Fourth, mortality rates after the first 3 months of ART in all age groups were consistently lower than before therapy or during the first 3 months, despite children being relatively old at ART initiation and often being severely immunocompromised. Loss-to-programme rates were twice as high but followed similar trends in all age groups.…”

Surveillance of Molecular Markers of Plasmodium falciparum Resistance to Sulphadoxine-Pyrimethamine 5 Years after the Change of Malaria Treatment Policy in Ghana

“…42 Co-trimazole is also used for prophylaxis in human immunodeficiency virus (HIV)-exposed infants and HIV-infected individuals in Africa, which may also enhance the effect of drug pressure in countries with a high prevalence of HIV. [43][44][45] With the current trend in prevalence of mutations in circulating parasites, the use of SP alone for IPTp needs to be closely monitored to avoid putting women at risk of getting malaria during pregnancy. Should SP be maintained as the drug of choice for IPTp/IPTi/IPTc in most endemic countries, we then suggest a review of the mode of dispensing that should be preserved for IPT use only.…”

Pathogens and pharmaceuticals in source-separated urine in eThekwini, South Africa

“…The ubiquitous detection of sul1 in the present study thus encourages further evaluation of the prevalence and health risks associated with other clinically relevant ARGs in source-separated urine, and especially those harbored within human pathogens. Despite the potential health challenges from the spread of antibiotic resistance, HIV-infected African adults receiving cotrimoxazole currently still garner consistent benefits in survival even in areas where co-trimoxazole resistance is common (Zachariah et al, 2007). Beyond the human health concerns associated with antibiotic resistance determinants, pharmaceutical usage and environmental release pose potential ecotoxicological risks.…”

“…Commonly prescribed antibacterial compounds with high excretion rates may also be prevalent in source-separated urine. Sulfamethoxazole and trimethoprim, for example, are frequently prescribed together as a broad-spectrum prophylaxis against bacterial pathogens and protozoa for HIV-positive patients (Zachariah et al, 2007). One potential human health consequence of such widespread use of antibiotics for infectious disease therapy is the accelerated propagation of antibiotic resistance, especially in low-income countries (Okeke et al, 2005).…”