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

被引:45
|
作者
Watera, Christine
Todd, Jim [1 ]
Muwonge, Richard
Whitworth, James
Nakiyingi-Miiro, Jessica
Brink, Anne
Miiro, George
Antvelink, Lucy
Kamali, Anatoli
French, Neil
Mermin, Jonathan
机构
[1] London Sch Hyg & Trop Med, Infect Dis Epidemiol Unit, Keppel St, London WC1E 7HT, England
[2] Uganda Virus Res Inst, Med Res Council Programme AIDS, Entebbe, Uganda
[3] AIDS Support Org TASO, Entebbe, Uganda
[4] Univ Liverpool Liverpool Sch Trop Med, Liverpool, Merseyside, England
基金
英国医学研究理事会;
关键词
Africa; HIV/AIDS mortality; morbidity; epidemiology; microbical drug resistance; opportunistic infections;
D O I
10.1097/01.qai.0000221679.14445.1b
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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.
引用
收藏
页码:373 / 378
页数:6
相关论文
共 50 条
  • [41] Intrusive HIV-1-infected cells
    Dominika Rudnicka
    Olivier Schwartz
    Nature Immunology, 2009, 10 : 933 - 934
  • [42] HIV-1 SEROPREVALENCE RATES IN WOMEN ATTENDING A PRENATAL CLINIC IN KAMPALA, UGANDA
    HOM, DL
    GUAY, L
    MMIRO, F
    NDUGWA, C
    KATAAHA, P
    BALL, P
    GOLDFARB, J
    MUGISHA, NK
    OLNESS, K
    HOUSER, HB
    PEDIATRIC AIDS AND HIV INFECTION-FETUS TO ADOLESCENT, 1993, 4 (02): : 74 - 77
  • [43] Lipodystrophy in HIV-1-infected patients
    Domingo, P
    Pérez, A
    Torres, OH
    Montiel, JA
    Vázquez, G
    LANCET, 1999, 354 (9181): : 868 - 868
  • [44] MICROSPORIDIOSIS IN HIV-1-INFECTED INDIVIDUALS
    BLANSHARD, C
    GAZZARD, BG
    LANCET, 1991, 337 (8755): : 1488 - 1489
  • [45] Uncovering HIV-1-infected cells
    Veillette, Maxime
    Richard, Jonathan
    Finzi, Andres
    ONCOTARGET, 2015, 6 (26) : 21791 - 21792
  • [46] Dysfunctional HDL and progression of atherosclerosis in HIV-1-infected and -uninfected adults
    Kelesidis, Theodoros
    Yang, Otto O.
    Kendall, Michelle A.
    Hodis, Howard N.
    Currier, Judith S.
    LIPIDS IN HEALTH AND DISEASE, 2013, 12
  • [47] Increased Risk for Severe Malaria in HIV-1-infected Adults, Zambia
    Chalwe, Victor
    Van Geertruyden, Jean-Pierre
    Mukwamataba, Doreen
    Menten, Joris
    Kamalamba, John
    Mulenga, Modest
    D'Alessandro, Umberto
    EMERGING INFECTIOUS DISEASES, 2009, 15 (05) : 749 - 755
  • [48] Predictors of mortality in a cohort of HIV-1-infected adults in rural Africa
    Erikstrup, Christian
    Kallestrup, Per
    Zinyama, Rutendo
    Gomo, Exnevia
    Mudenge, Boniface
    Gerstoft, Jan
    Ullum, Henrik
    JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2007, 44 (04) : 478 - 483
  • [49] Growth hormone enhances thymic function in HIV-1-infected adults
    Napolitano, Laura A.
    Schmidt, Diane
    Gotway, Michael B.
    Ameli, Niloufar
    Filbert, Erin L.
    Ng, Myra M.
    Clor, Julie L.
    Epling, Lorrie
    Sinclair, Elizabeth
    Baum, Paul D.
    Li, Kai
    Killian, Marisela Lua
    Bacchetti, Peter
    McCune, Joseph M.
    JOURNAL OF CLINICAL INVESTIGATION, 2008, 118 (03): : 1085 - 1098