Should cotrimoxazole prophylaxis be taken by all adults with HIV in Africa?

Mermin, Jonathan; Lule, John; Ekwaru, John Paul; Pitter, Christian

doi:10.1097/01.aids.0000168986.12832.a4

Cited by 11 publications

(9 citation statements)

References 4 publications

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“…This study also revealed that among the control group (those who were not on TMP-SMX prophylaxis), gradual increase in trend of TMP-SMX resistance was seen over time ( Figure 4). This is in contrast to the study by Mermin et al in Uganda which showed that antimicrobial resistance among diaorrheal pathogens infecting family members did not increase (Mermin et al, 2005b). This increase was attributed to the use of Ampiclox and Sulfadoxine-Pyrimethamine in the preceding month.…”

Section: Discussioncontrasting

confidence: 94%

EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FEACAL CARRIAGE RATES OF RESISTANT ISOLATES OF Escherichia Coli IN HIV-INFECTED ADULT PATIENTS IN LAGOS

Egwuatu¹,

Ogunsola²,

Iwuafor³

et al. 2016

AJID

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Background: The daily use of Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis reduces morbidity and mortality among patients infected with human immunodeficiency virus (HIV) but its impact on increasing antimicrobial resistance rates has been of public health concern, globally. This study investigated the effect of daily TMP-SMX prophylaxis on feacal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. Methods: A total of 550 HIV-infected patients with CD4-cell counts of less than 350 cells/mm 3 who were eligible for TMP-SMX prophylaxis and attending Lagos University Teaching Hospital, Lagos, Nigeria, were recruited for this study. Stool/rectal swab samples were aseptically collected from the patients and processed using standard methods for culture and sensitivity. Results: There was a baseline Trimethoprim-Sulfamethoxazole resistance rate of 54% which increased to 77.9% in first 3 months, rising to 96.1% by 6 months and all isolates were resistant by the 9th month. There was also evidence of cross-resistance to other antibiotics with significance in association with TMP-SMX resistance (p<0.0001). The Escherichia coli isolates showed a progressive increase in resistance to the tested antibiotics over the 12-month period. The resistance was in the following order: Ampicillin (74% to 82.6% in the first 3 months; 98.3% by the 6th month and 99.4% by the 9th month; all isolates were resistant by the 12th month), Augmentin (32.5% to 47.7% in first 3 months; 76.1% by the 6th month; 86.3% by the 9th month; all isolates were resistant by 12 months), Ceftriaxone (2.0% to 10.8% in first 3 months; 20.6% by the 6th month; 24.2% by the 9th month; 54.3% by the 12 months). Conclusions:The carriage rate of feacal E. coli resistant to TMP-SMX is common before TMP-SMX prophylaxis. Initiation of TMP-SMX leads to further increase in resistance to TMP-SMX and cross-resistance to other antimicrobials.

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Section: Discussioncontrasting

confidence: 94%

EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FEACAL CARRIAGE RATES OF RESISTANT ISOLATES OF Escherichia Coli IN HIV-INFECTED ADULT PATIENTS IN LAGOS

Egwuatu¹,

Ogunsola²,

Iwuafor³

et al. 2016

AJID

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“…This decision to provide prophylaxis was made by staff at the blood donor medical centre, and although it might have seemed an over-reaction 10 years ago, it has recently been recognized as a valid option. 18 This prophylaxis may have contributed to a decrease in early morbidity in our study group and could explain the difference in morbidity between our cohort and those in other low-resource settings.…”

Section: Discussionmentioning

confidence: 68%

Progression to WHO criteria for starting antiretroviral therapy in a 7-year cohort of adult HIV-1 seroconverters in Abidjan, Cote d'Ivoire

Minga

Danel

Abo

et al. 2007

Bull World Health Organ

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Objective To estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire. Methods We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was < 36 months. Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity. We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines. Findings 217 adults (77 women (35%)) were followed up during 668 person-years (PY). The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.6/100 PY), herpes zoster (3.4/100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY). The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0.16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively. Conclusion Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa.Bulletin of the World Health Organization 2007;85: 116-123. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. IntroductionExperts from the World Health Organization (WHO) and the United Nations Joint Programme on AIDS (UNAIDS) have estimated that at the end of 2005, 65% of the 39 million people with HIV worldwide were living in sub-Saharan Africa. 1 In Africa, only a small proportion of people who need highly active antiretroviral therapy (HAART) are currently being treated. However, the number who receive HAART has been increasing rapidly since 2004, and will continue to increase within the next few years thanks to national and international funds and initiatives.In 2003 and 2006, WHO experts defined criteria for initiating HAART in low-resource areas based on clinical criteria and, depending on the availability of laboratory facilities, either CD4 count or total lymphocyte count. Since cohort studies of patients from the time of HIV seroconversion are rare, little is known Methods PatientsRecruitment for the The Primo-CI ANRS 1220 prospective cohort started in 1997 in the HIV care clinic (FonSIDA clinic) of the Centre National de Transfusion Sanguine (CNTS), at the national blood bank of Abidjan.2 The study protocol was approved by the ethics committees of the national Ivorian program on AIDS and the institutional review board of the French Agency for Research on AIDS (ANRS).In the Côte d'Ivoire, blood donors are adult volunteers who are not paid. Blood donations are limited to five per year in men and four per year in women. ...

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“…Prior to the availability of ART, data on the benefits of cotrimoxazole prophylaxis regardless of CD4+T cell count influenced Uganda Ministry of Health and WHO policy [12,16,17]. Similar benefits may be seen in people with HIV taking ART.…”

Section: Discussionmentioning

confidence: 99%

The effect of opportunistic illness on HIV RNA viral load and CD4+ T cell count among HIV‐positive adults taking antiretroviral therapy

Ekwaru

Campbell

Malamba

et al. 2013

Journal of the International AIDS Society

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IntroductionHIV RNA viral load (VL) has been shown to increase during opportunistic illnesses (OIs), suggesting active HIV replication in response to infection among patients not taking antiretroviral therapy (ART). We assessed the effects of OIs on HIV RNA VL and CD4+ T cell counts among patients on ART with initially suppressed VL.MethodsBetween 2003 and 2007, we enrolled and followed 1094 HIV-1-infected adults who initiated ART and had quarterly blood draws for VL and CD4+ T cell count. In VL/CD4+ T cell measurement intervals following undetectable VL, we compared the elevation in VL to detectable levels and CD4+ T cell count changes between intervals when participants had episodes of OIs and intervals when they did not have OIs.ResultsVL was more likely to be detectable if participants had OIs in the prior three months compared to when they did not (OR=4.0 (95% CI=1.9–8.6)). The CD4+ T cell counts declined 24.1 cells/µL per three months in intervals where the participants had OIs compared to an increase of 21.3 cells/µL per three months in intervals where they did not have OIs (adjusted difference in the rate of CD4+ T cell count change of 61.7 cells/µL per three months (95% CI=13.7–109.7), P value=0.012). The rate of CD4+ T cell count increase was 25.6 cells/µL per three months (95% CI=11.6–39.6) higher for females compared to males (p value=<0.001), 1.4 cells/µL per three months lower per one year increase in age (p value=0.046) and 4 cells/µL per three months lower per 10 cells/µL increase in the starting CD4+ T cell count value (p value=<0.001).ConclusionEpisodes of opportunistic infections among patients taking ART with undetectable VL were associated with elevation of HIV RNA VL to detectable levels and decline in CD4+ T cell counts.Clinical Trial Number: NCT00119093.

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Should cotrimoxazole prophylaxis be taken by all adults with HIV in Africa?

Cited by 11 publications

References 4 publications

EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FEACAL CARRIAGE RATES OF RESISTANT ISOLATES OF Escherichia Coli IN HIV-INFECTED ADULT PATIENTS IN LAGOS

EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FEACAL CARRIAGE RATES OF RESISTANT ISOLATES OF Escherichia Coli IN HIV-INFECTED ADULT PATIENTS IN LAGOS

Progression to WHO criteria for starting antiretroviral therapy in a 7-year cohort of adult HIV-1 seroconverters in Abidjan, Cote d'Ivoire

The effect of opportunistic illness on HIV RNA viral load and CD4+ T cell count among HIV‐positive adults taking antiretroviral therapy

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