This article is more than 5 years old. Information may no longer be current.
Co-trimoxazole discontinuation increases morbidity in malaria-endemic regions
Click Here to Manage Email Alerts
Discontinuation of co-trimoxazole prophylaxis among HIV patients in malaria-endemic regions resulted in an increased number of malaria cases, according to a study recently published in PLOS Medicine.
“Recommendations for [co-trimoxazole (CTX)] use in adults with HIV-1 vary by setting,” the researchers wrote. “In the United States and Europe, CTX is recommended for HIV-1 infected adults with severe immunosuppression to prevent Pneumocystis jiroveci pneumonia and toxoplasmosis.
“In resource-limited countries, the threshold for CTX discontinuation following ART remains undefined.”
Researchers recruited adult Kenyans with HIV infection to an unblinded, randomized noninferiority trial from February 2012 to Aug. 27, 2012. Eligible participants were receiving first-line ART for at least 18 months, taking CTX for any amount of time and demonstrating counts greater than 350 cells/mm3. Researchers conducted follow-up visits every 3 months for 1 year to determine morbidity, mortality and incidence rates among patients randomly assigned to maintain or discontinue CTX treatment.
There were 500 HIV patients enrolled, with 250 randomly assigned to each study arm. The median age at enrollment was 40 years, and 72% of participants were women. Median duration of ART and CD4 count was 4.5 years and 595 cells/mm3. Study retention was similar within both groups, with 98% of all participant retained to the end of follow-up.
The researchers observed 111 morbidity events, consisting of diarrhea (n = 59), malaria (n = 34), pneumonia (n = 17) and death (n = 1). The estimated rate of these events was greater in the discontinuation arm (30.4 events per 100 person years) than in the continuation arm (13.4 events per 100 person-years; P < .001). This difference was primarily attributed to the higher instance of malaria within the discontinuation arm (13 events per 100 person-years vs. 0.4 events per 100 person-years). Furthermore, adverse events and serious adverse events were more frequent in the discontinuation group, which led the researchers to conclude CTX discontinuation inferior to CTX continuation in this region.
“CTX discontinuation among ART-treated adults in a region with endemic malaria results in increased incidence of clinical malaria but not pneumonia or diarrhea,” they wrote. “The implications are broad, and our results suggest that CTX prophylaxis should continue in regions with endemic malaria. However, in regions without malaria or with less endemicity, CTX cessation may be possible after immune recovery.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts