Antibiotic Reduces Mortality in African AIDS Patients

Trial analysis finds 35 percent overall decrease in 72-week mortality with co-trimoxazole
By Jeff Muise
HealthDay Reporter

MONDAY, March 29 (HealthDay News) -- Prophylactic daily administration of the inexpensive and widely-used antibiotic co-trimoxazole among HIV-infected African patients beginning triple-drug antiretroviral therapy improved mortality for up to 72 weeks after the start of treatment, according to a study published online March 29 in The Lancet.

A. Sarah Walker, Ph.D., of the MRC Clinical Trials Unit in London, and colleagues assessed the effectiveness of co-trimoxazole (trimethoprim-sulfamethoxazole) in HIV-infected, symptomatic patients with CD4 counts lower than 200 cells per µL commencing triple-drug antiretroviral therapy in the Development of Anti-Retroviral Therapy in Africa (DART) trial. The researchers evaluated CD4 cell count, the incidence of infection, and body mass index (BMI) through 72 weeks of treatment.

The researchers analyzed data from 3,179 participants who contributed 14,214 years of follow-up with 8,128 (57 percent) person-years on co-trimoxazole. They found that prophylactic use of co-trimoxazole reduced mortality risk 35 percent overall, with a 59 percent in the initial 12 weeks and a 44 percent reduction for 12 to 72 weeks; however, there was no significant risk reduction observed beyond 72 weeks. Co-trimoxazole prophylaxis also reduced incidence of malaria by 26 percent, but did not appear to have a significant effect on new World Health Organization stage 4 events, CD4 cell count, or BMI.

"Our results reinforce WHO guidelines and provide strong motivation for provision of co-trimoxazole prophylaxis for at least 72 weeks for all adults starting combination antiretroviral therapy in Africa," the authors write.

The study was funded in part by GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim and Abbott Laboratories.

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