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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, Neil and Mermin, J. (2006) 'Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1-infected adults attending an HIV/AIDS clinic in Uganda'. Jaids-Journal of Acquired Immune Deficiency Syndromes, Vol 42, Issue 3, pp. 373-378.

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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
Uncontrolled 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
Subjects: QV Pharmacology > QV 38 Drug action.
QV Pharmacology > QV 4 General works
WA Public Health > Preventive Medicine > WA 108 Preventive health services. Preventive medicine. Travel Medicine.
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.1097/01.qai.0000221679.14445.1b
Depositing User: Sarah Lewis-Newton
Date Deposited: 13 Apr 2011 15:09
Last Modified: 06 Feb 2018 13:02
URI: https://archive.lstmed.ac.uk/id/eprint/1628

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