Lower Early Mortality Rates Among Patients Receiving Antiretroviral Treatment at Clinics Offering Cotrimoxazole Prophylaxis in Malawi

OBJECTIVE:To determine whether Malawi antiretroviral treatment (ART) clinics providing cotrimoxazole (CTX) prophylaxis had lower early mortality rates compared with clinics not providing CTX. METHODS:Retrospective cohort study of eleven ART clinics in Malawi that were or were not providing CTX. Medi...

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Published in:	Journal of acquired immune deficiency syndromes (1999) Vol. 46; no. 1; pp. 56 - 61
Main Authors:	Lowrance, David, Makombe, Simon, Harries, Anthony, Yu, Joseph, Aberle-Grasse, John, Eiger, Odette, Shiraishi, Ray, Marston, Barbara, Ellerbrock, Tedd, Libamba, Edwin
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-09-2007 Lippincott Williams & Wilkins Lippincott Williams & Wilkins Ovid Technologies
Subjects:	Adolescent Adult Aged AIDS/HIV Anti-HIV Agents - therapeutic use Antiretroviral drugs Biological and medical sciences Cohort Studies Dose-Response Relationship, Drug Drug therapy Female Fundamental and applied biological sciences. Psychology HIV Infections - complications HIV Infections - drug therapy HIV Infections - mortality Human viral diseases Humans Infectious diseases Intervention Malawi - epidemiology Male Medical sciences Microbiology Middle Aged Miscellaneous Mortality Pneumonia, Pneumocystis - prevention & control Retrospective Studies Survival analysis Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Virology Malawi Africa Human HIV/AIDS Immunopathology Antiretroviral agent Microbiology Retroviridae Trimethoprim AIDS cotrimoxazole prophylaxis Immune deficiency Lentivirus antiretroviral treatment Virology Infection Virus Prevention resource-limited setting early mortality Sulfamethoxazole Treatment Malawi Viral disease Antiviral Human immunodeficiency virus
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Summary:	OBJECTIVE:To determine whether Malawi antiretroviral treatment (ART) clinics providing cotrimoxazole (CTX) prophylaxis had lower early mortality rates compared with clinics not providing CTX. METHODS:Retrospective cohort study of eleven ART clinics in Malawi that were or were not providing CTX. Medical record abstraction was performed for all patients (N = 1295) initiating ART between July 1 and December 15, 2005. At 5 ART sites, CTX was given to patients dosed at 960 mg daily or 480 mg twice a day (according to national guidelines). RESULTS:When all defaults (patients lost to follow-up for >90 days) were excluded from the analysis, the 6-month mortality rate was 10.7% in patients receiving ART at CTX clinics compared with 18.0% in those not at CTX clinics (6-month mortality risk reduction = 40.7%; P = 0.0013). Kaplan-Meier survival curves for patients receiving CTX and patients not receiving CTX were significantly different; survival differences were apparent as early as 40 to 45 days after initiation of ART. CONCLUSIONS:Patients receiving ART in Malawi at clinics offering CTX prophylaxis had significantly reduced mortality during the first 6 months of ART. This additional intervention may have the potential to improve the lives of patients on ART, because CTX is readily available and relatively inexpensive and can, in principle, be easily introduced into ART delivery programs.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1525-4135 1944-7884
DOI:	10.1097/QAI.0b013e3181378ed2