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Titolo:
Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Cote d'Ivoire: a randomised trial
Autore:
Anglaret, X; Chene, G; Attia, A; Toure, S; Lafont, S; Combe, P; Manlan, K; NDri-Yoman, T; Salamon, R;
Indirizzi:
CHU Treichville, Ctr Diagnost & Rech SIDA, Abidjan 01, Cote Ivoire CHU Treichville Abidjan Cote Ivoire 01 ech SIDA, Abidjan 01, Cote Ivoire Univ Bordeaux 2, INSERM, U330, F-33076 Bordeaux, France Univ Bordeaux 2 Bordeaux France F-33076 , U330, F-33076 Bordeaux, France CHU Yopougon, Med Serv, Abidjan, Cote Ivoire CHU Yopougon Abidjan Cote Ivoire pougon, Med Serv, Abidjan, Cote Ivoire
Titolo Testata:
LANCET
fascicolo: 9163, volume: 353, anno: 1999,
pagine: 1463 - 1468
SICI:
0140-6736(19990501)353:9163<1463:ECWTFH>2.0.ZU;2-9
Fonte:
ISI
Lingua:
ENG
Soggetto:
HUMAN-IMMUNODEFICIENCY-VIRUS; WEST-AFRICAN CITY; DEVELOPING-WORLD; IVORY-COAST; HIV; INFECTION; KENYA; SULFAMETHOXAZOLE; COTRIMOXAZOLE; PROPHYLAXIS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
26
Recensione:
Indirizzi per estratti:
Indirizzo: Anglaret, X CHUireeichville, Ctr Diagnost & Rech SIDA, 01 BP 1839, Abidjan01, Cote Ivo CHU Treichville 01 BP 1839 Abidjan Cote Ivoire 01 1, Cote Ivo
Citazione:
X. Anglaret et al., "Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Cote d'Ivoire: a randomised trial", LANCET, 353(9163), 1999, pp. 1463-1468

Abstract

Background In sub-Saharan Africa, various bacterial diseases occur before pneumocystosis or toxoplasmosis in the course of HIV-1 infection, and are major causes of morbidity and mortality. We did a randomised, double blind, placebo-controlled clinical trial at community-health centres in Abidjan, Cote d'Ivoire, to assess the efficacy of trimethoprim-sulphamethoxazole (co-trimoxazole) chemoprophylaxis at early stages of HIV-1 infection. Method 843 HIV-infected patients were screened and 545 enrolled in the study. Eligible adults (with HIV-1 or HIV-1 and HIV-2 dual seropositivity at stages 2 or 3 of the WHO staging system) received co-trimoxazole chemoprophylaxis (trimethoprim 160 mg, sulphamethoxazole 800 mg) daily or a matching placebo. The primary outcome was the occurrence of severe clinical events, defined as death or hospital admission irrespective of the cause. Analyses were by intention to treat. Findings Four of the randomised patients were excluded (positive for HIV-2only). 120 severe events occurred among 271 patients in the co-trimoxazolegroup and 198 among 270 in the placebo group. Significantly fewer patientsin the co-trimoxazole group than in the placebo group had at least one severe event (84 vs 124); the probability of remaining free of severe events was 63.7% versus 45.8% (hazard ratio 0.57 [95% CI 0.43-0.75], p=0.0001) and the benefit was apparent in all subgroups of initial CD4-cell count. Survival did not differ between the groups (41 vs 46 deaths, p=0.51). Cotrimoxazole was generally well tolerated though moderate neutropenia occurred in 62 patients ( vs 26 in the placebo group). Interpretation Patients who might benefit from cotrimoxazole trimoxazole could be recruited on clinical criteria in community clinics without knowingthe patients CD4-cell count. This affordable measure will enable quick public-health intervention, while monitoring bacterial susceptibility and haematological tolerance.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/07/20 alle ore 03:51:03