Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1-infected adults attending an HIV/AIDS clinic in Uganda


Watera, C; Todd, J; Muwonge, R; Whitworth, J; Nakiyingi-Miiro, J; Brink, A; Miiro, G; Antvelink, L; Kamali, A; French, N; Mermin, J; (2006) Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1-infected adults attending an HIV/AIDS clinic in Uganda. Journal of acquired immune deficiency syndromes (1999), 42 (3). pp. 373-378. ISSN 1525-4135 DOI: https://doi.org/10.1097/01.qai.0000221679.14445.1b

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Abstract

Background: Cotrimoxazole is recommended for prevention of opportunistic infections in symptomatic HIV patients in sub-Saharan Africa. Methods: We examined the feasibility and effectiveness of daily cotrimoxazole prophylaxis in a well-established cohort of HIV-infected adults attending clinics in Entebbe, Uganda. We compared mortality and morbidity rates for 12 months before and after the introduction of cotrimoxazole. Results: Between August 2000 and February 2002, 94% of cohort members were enrolled onto cotrimoxazole prophylaxis. Revisits were scheduled every 4 weeks to replenish pills; patients attended 61% of revisits. The main reasons for nonenrollment and defaulting were lack of transport, being away from home, and sickness. Drug-related adverse events, mainly itching and rash, were seen in 4% of participants. Although bacterial resistance rate to cotrimoxazole was high, the adjusted mortality incidence rate ratio was significantly reduced after the introduction of cotrimoxazole (0.76; 95% confidence interval, 0.60-0.96; P = 0.020). Overall febrile events and morbidity rates were unchanged after the introduction of cotrimoxazole, but the incidence of malaria was reduced (incidence rate ratio, 0.31; 95% confidence interval, 0.13-0.72). Conclusions: Cotrimoxazole prophylaxis can be introduced into routine HIV clinic activities and is associated with a reduction in overall mortality and malaria morbidity, even in all area with high bacterial resistance. These results reinforce the need for large-scale provision of cotrimoxazole prophylaxis for all HIV-positive patients in developing countries.

Item Type: Article
Keywords: Africa, HIV/AIDS mortality, morbidity, epidemiology, microbical drug, resistance, opportunistic infections, Trimethoprim-sulfamethoxazole prophylaxis, plasmodium-falciparum, positive tuberculosis, reduces mortality, controlled-trial, hiv-infection, cote-divoire, resistance, morbidity, efficacy
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Population Studies Group
PubMed ID: 16810124
Web of Science ID: 238766800017
URI: http://researchonline.lshtm.ac.uk/id/eprint/11621

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