An Inexpensive Antibiotic Proves Effective in Reducing Death Among People with HIV and TB in Africa
A joint study by the Centers for Disease Control and Prevention (CDC) and the Côte d'Ivoire Ministry of Public Health has found the first evidence that trimethoprim/sulfamethoxazole (TMP/SMX) (commonly referred to as cotrimoxazole, Bactrim or Septra) can significantly reduce the rate of death a offer a realistic option to help reduce the overwhelming death toll from HIV in the developing world -- where over 90% of new HIV infections occur.
While TMP/SMX is standard care for AIDS patients in the United States, the drug is most often used to prevent Pneumocystis carinii pneumonia (PCP). Because PCP is rare in Africa, the drug is not commonly used there to prevent infections among HIV-infected persons. Before now, it was not known if TMP/SMX would prevent the most common causes of illness and death among persons with both HIV infection and TB in African nations.
HIV-infected TB patients were studied because they have a high death rate, even if they are cured of TB. This high death rate is likely due to the other common causes of severe illness and death among HIV-infected individuals in Africa, such as toxoplasmosis, salmonellosis, pneumococcal pneumonia, and bacteremia. This collaborative study was undertaken to determine if these diseases could be prevented with TMP/SMX.
The study, begun in October 1995, analyzed the effectiveness of a daily dose of 800 mg of trimethoprim and 160 mg of sulfamethoxazole. The drug was started one month after the initiation of standard TB treatment to distinguish side effects of the drug from those due to the TB treatment. The results show that this antibiotic is both safe and effective in preventing these diseases, with the greatest efficacy seen among persons with the most advanced HIV disease.
CDC has begun to share these findings with public health agencies worldwide, and is actively working to help translate these findings into effective health care practice where possible. More information is needed to determine whether HIV-infected patients without TB would benefit from this preventive therapy, but researchers believe this therapy will make a significant difference in lives saved and improved quality of life for HIV-infected tuberculosis patients in Africa and other developing nations. Among HIV-infected tuberculosis (TB) patients in Africa.
Although preliminary results were reported last year at the 12th World AIDS Conference in Geneva, the final data, released in the May 1, 1999 issue of the Lancet, show a 46% reduction in mortality and a 43% reduction in hospitalizations among HIV-infected TB patients taking TMP/SMX.
This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.