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Antibiotic halves number of AIDS related deaths in children in Zambian study

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7477.1258-b (Published 25 November 2004) Cite this as: BMJ 2004;329:1258
  1. Debashis Singh
  1. London

    All children with HIV in developing countries should be given prophylactic co-trimoxazole, a cheap and widely available antibiotic, a research paper from the Medical Research Council says (Lancet 2004;364:1865-71).

    The study found that a daily dose of the antibiotic resulted in a 43% lower mortality in children with HIV in Lusaka, Zambia, who were treated with the antibiotic than in a matched group of children taking a placebo, by preventing opportunistic infections irrespective of local antibiotic resistance. Co-trimoxazole also reduced admission rates to the University Teaching Hospital in Lusaka by 23%. The improvement in mortality was seen in all age groups.

    The data and safety monitoring committee of the study, the children with HIV antibiotic prophylaxis (CHAP) trial, prematurely ended the trial when it became clear that mortality in children taking the antibiotic was sustained and significantly lowered.

    The double blind, randomised controlled trial, which was backed by the UK government, recruited 541 children from Lusaka aged between 1 and 14 years with clinical features that indicated HIV infection and a positive result to an HIV antibody test. They were then randomly assigned to either the antibiotic or placebo. The children were treated for nearly 20 months from 2001 to October 2003, when the trial was halted.

    Co-trimoxazole is a long established antibiotic that has been used worldwide for many years in the treatment of community acquired infections. It is especially effective in treating Pneumocystis carinii pneumonia, one of the earliest opportunistic infections to arise in patients with a weakened immunity.

    The exact mechanism of action of prophylaxis with co-trimoxazole is not clear, because although the proportion of children dying of lung disease seemed to be lower in the co-trimoxazole group, the effect did not seem to be related to Pneumocystis carinii,as no cases of the infection were isolated, says the paper.

    The research team concluded that co-trimoxazole should be given to all children with HIV in Africa, regardless of age and CD4 count. As a result of the trial the World Health Organization and Unicef are changing their advice on effective drugs for children with HIV.

    Every day as many as 1300 children around the world die from AIDS, according to the 2004 report from UNAIDS, the joint United Nations programme on HIV/AIDS. By the end of 2003 2.1 million children in the world were infected with HIV, 1.9 million in Africa alone, according to the report.

    Dr Diana Gibb of the Medical Research Council's Clinical Trials Unit, who led the study, said, “All children in the trial are now on preventative co-trimoxazole, and children in the trial who needed antiretroviral therapy are now starting it through the Zambian government scheme.”

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