Prophylaxis with co-trimoxazole for HIV infected adults in Africa

doi:10.1136/bmj.a304

Published 9 July 2008, doi:10.1136/bmj.a304
Cite this as: BMJ 2008;337:a304

Editorials

Prophylaxis with co-trimoxazole for HIV infected adults in Africa

Co-trimoxazole reduces mortality even in settings where bacterialresistance may be high

The first 150 words of the full text of this article appear below.

In their linked study, Nunn and colleagues report the resultsof a placebo controlled trial of co-trimoxazole prophylaxisin HIV positive Zambian adults being treated for tuberculosis.They found that co-trimoxazole significantly reduced mortality(hazard ratio 0.79, 95% confidence interval 0.63 to 0.99), andthey conclude that the findings strengthen the evidence basefor the World Health Organization and the Joint United NationsProgramme on HIV/AIDS (UNAIDS) guidelines issued in 2000.¹

We applaud these findings and agree with the conclusion, yetwe remain frustrated. The results echo several others publishedsince 1999, but despite the overwhelming body of evidence thefindings have been only partially translated into practice.²³ ⁴ ⁵ ⁶ ⁷ ⁸ ⁹

Prophylaxis with co-trimoxazole was used in industrialised countriestwo decades before it appeared in Africa. In the early 1980s,co-trimoxazole was already being used to prevent bacterial infectionsin people with granulocytopenia who were HIV negative. In thelate 1980s and early . . . [Full text of this article]

Xavier Anglaret, senior researcher¹, Serge Eholie, professor of infectious diseases²

¹ INSERM, U593, Université Bordeaux 2, 33076 Bordeaux, France, ² Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d’Ivoire

Xavier.Anglaret@isped.u-bordeaux2.fr