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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
HIV-infected ugandan adults taking antiretroviral therapy with CD4 counts >200 cells/μL who discontinue cotrimoxazole prophylaxis have increased risk of malaria and diarrhea
Clinical Infectious Diseases, Volume 54, No. 8, Year 2012
Notification
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Description
Background. Cotrimoxazole prophylaxis prolongs survival and prevents opportunistic infections, malaria, and diarrhea in persons infected with human immunodeficiency virus (HIV). Many countries recommend that individuals taking antiretroviral therapy (ART) discontinue cotrimoxazole when CD4 counts are >200 cells/μL. However, this practice has not been evaluated in sub-Saharan Africa.Methods.Patients in the Home-Based AIDS Care program in eastern Uganda initiated ART if they had a CD4 cell count ≤250 cells/μL or World Health Organization stage III or IV HIV disease. In the program's fourth year, patients with CD4 counts >200 cells/μL were randomly assigned, by household, to continue or discontinue cotrimoxazole. Consenting participants were followed for episodes of malaria and diarrhea. Results. At randomization, 836 eligible patients had been receiving ART for a mean of 3.7 years, with a median CD4 count of 489 cells/μL; 94% had a viral load <400 copies/mL. Among those continuing (n = 452) vs discontinuing (n = 384) cotrimoxazole, 0.4 vs 12.2%, respectively, had at least 1 episode of malaria (P <. 001), and 14% vs 25%, respectively, had at least 1 episode of diarrhea (P <. 001). Compared to those remaining on cotrimoxazole, patients who discontinued had a relative risk of malaria of 32.5 (95% confidence interval [CI], 8.6-275.0; P <. 001) and of diarrhea of 1.8 (95% CI, 1.3-2.4; P <. 001).Conclusions. HIV-infected adults on ART with CD4 counts >200 cells/μL who live in a malaria-endemic area of sub-Saharan Africa and who abruptly discontinue cotrimoxazole prophylaxis have an increased incidence of malaria and diarrhea compared with those who continue prophylaxis.Clinical Trials Registration.NCT00119093. © 2012 The Author.
Authors & Co-Authors
Campbell, James D.
Uganda, Entebbe
Uganda Virus Research Institute
Moore, David M.
Canada, Vancouver
British Columbia Centre for Excellence in Hiv-aids
Canada, Vancouver
The University of British Columbia
Degerman, Richard
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Kaharuza, Frank M.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Were, Willy A.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Muramuzi, Emmy
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Odongo, George S.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Wetaka, Milton Makoba
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Mermin, Jonathan H.
Uganda, Entebbe
Uganda Virus Research Institute
Tappero, Jordan W.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Statistics
Citations: 64
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1093/cid/cis013
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Uganda