Prophylaxis with co-trimoxazole for HIV infected adults in Africa

doi:10.1136/bmj.a304

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

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

Xavier.Anglaret{at}isped.u-bordeaux2.fr

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

In their linked study, Nunn and colleagues report the results of a placebo controlled trial of co-trimoxazole prophylaxis in 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), and they conclude that the findings strengthen the evidence base for the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) guidelines issued in 2000.1

We applaud these findings and agree with the conclusion, yet we remain frustrated. The results echo several others published since 1999, but despite the overwhelming body of evidence the findings have been only partially translated into practice.2 3 4 5 6 7 8 9

Prophylaxis with co-trimoxazole was used in industrialised countries two decades before it appeared in Africa. In the early 1980s, co-trimoxazole was already being used to prevent bacterial infections in …