Impact of daily cotrimoxazole prophylaxis in severely immunosuppressed adults in Africa started on combination ART in the DART trial.
This conference poster presents information on the DART trial design; patients follow-up and data; statistical methods; the effect of cotrimoxazole prophylaxis on clinical outcomes; cotrimoxazole prophylaxis and mortality; causes of death; and the effect of cotrimoxazole prophylaxis on CD4 count and BMI. The following conclusions are given:
- cotrimoxazole prophylaxis halved mortality in HIV-infected adults in the first 12 weeks on antiretroviral therapy (ART), an effect sustained to 72 weeks. It was not possible to identify how the benefits of cotrimoxazole prophylaxis were achieved or to draw any conclusions about mechanism of action. No significant effects of cotrimoxazole prophylaxis were observed on WHO stage 3 or 4 events, CD4 counts or BMI.
- the impact of cotrimoxazole prophylaxis on malaria in Uganda was significant and sustained beyond the impact on survival.
- cotrimoxazole prophylaxis should be provided in ART rollout programs in resource-limited settings for up to 72 weeks; after this it may be reasonable to stop.
Gilks, C.F.; Ford, D.; Walker, A.S.; Munderi, P.; Hakim, J.; Kityo, C.; Lutwama, F.; Grosskurth, H.; Reid, A.; Ssali, F.; Mugyenyi, P.; Gibb, D.M.; Babiker, A.G. Impact of daily cotrimoxazole prophylaxis in severely immunosuppressed adults in Africa started on combination ART in the DART trial. Presented at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Cape Town, South Africa, 19-22 July 2009. (2009) 1 pp.