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Co-trimoxazole prophylaxis reduces mortality in HIV-infected adults with TB.

The aim of this study was to assess the impact of prophylactic oral cotrimoxazole in reducing mortality in HIV-positive Zambian adults being treated for pulmonary tuberculosis, using a double-blind placebo-controlled randomised clinical trial.

Two groups of antiretroviral treatment-naive adults with HIV infection were enrolled: patients newly diagnosed as having tuberculosis and receiving tuberculosis treatment either for the first time or for retreatment after relapse; and previously treated patients not receiving treatment. The intervention was oral cotrimoxazole or matching placebo daily.

A total of 1 003 patients were randomised: 835 (416 co-trimoxazole, 419 placebo) were receiving treatment for tuberculosis, 762 (376 co-trimoxazole, 386 placebo) of them newly diagnosed, previously untreated patients and 73 (40 co-trimoxazole, 33 placebo) receiving a retreatment regimen; 168 (84 co-trimoxazole, 84 placebo) were not on treatment but had received treatment in the past. Of 835 participants receiving tuberculosis treatment, follow-up information was available for 757, with a total of 1 012.6 person years of follow-up. A total of 310 (147 cotrimoxazole, 163 placebo) participants died, corresponding to death rates of 27.3 and 34.4 per 100 person years. In the Cox regression analysis, the hazard ratio for death (co-trimoxazole:placebo) was 0.79 (95% confidence interval 0.63 - 0.99). The effect of co-trimoxazole waned with time, possibly owing to falling adherence levels; in a per protocol analysis based on patients who spent at least 90% of their time at risk supplied with the study drug, the hazard ratio was 0.65 (0.45 - 0.93).

The conclusions were that prophylaxis with co-trimoxazole reduces mortality in HIV-infected adults with pulmonary tuberculosis. Co-trimoxazole was generally safe and well tolerated.

Nunn AJ, et al. BMJ 2008; 337: a257.
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Title Annotation:AIDS briefs; tuberculosis
Author:Farham, Bridget
Publication:CME: Your SA Journal of CPD
Article Type:Brief article
Geographic Code:6SOUT
Date:Aug 1, 2008
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