TMP-SMZ Prophylaxis Prevents Bacterial Infections in Advanced HIV Disease -- HIV/AIDS INFO AND UPDATES

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Date Posted: 22:11:18 02/28/02 Thu
Author: Anonymous
Subject: TMP-SMZ Prophylaxis Prevents Bacterial Infections in Advanced HIV Disease

TMP-SMZ Prophylaxis Prevents Bacterial Infections in Advanced HIV Disease

NEW YORK (Reuters Health) Feb 15 - The results of a phase III randomized trial indicate that prophylactic treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) is superior to other medications in preventing bacterial infections in patients with advanced HIV disease who are not on highly active antiretroviral therapy (HAART).

Dr. A. Gregory DiRienzo, from the Harvard School of Public Health, Boston, and colleagues randomly assigned 842 HIV-positive patients, whose CD4+ counts were <200 cells per microliter, to a standard dose of zidovudine plus TMP-SMZ, dapsone, or aerosolized pentamidine. The researchers looked for infections every other week for 8 weeks and then once a month until the end of the study.

Intent-to-treat analysis showed that TMP-SMZ significantly reduced the risk for any bacterial infection compared with aerosolized pentamidine or dapsone (p = 0.02 and 0.01, respectively).

TMP-SMZ also significantly reduced the risk of infectious diarrhea compared with aerosolized pentamidine, the researchers found. The risk of sinusitis/otitis media and second occurrence of pneumonia was also significantly reduced with TMP-SMZ compared with aerosolized pentamidine or dapsone.

"The study was conducted before the advent of HAART, and therefore perhaps is not applicable to HIV-infected patients receiving potent antiretroviral therapy and who experience large immunologic and clinical benefits," the investigators comment in their report in the January 20th issue of AIDS Research and Human Retroviruses.

Dr. DiRienzo and colleagues conclude that "this study demonstrates the superiority of TMP-SMZ in the prevention of bacterial disease among patients with advanced HIV infection treated in the pre-HAART era."

However, "more than 90% of patients with AIDS worldwide have no or limited access to HAART. These results underscore the importance of TMP-SMZ prophylaxis for patients with advanced HIV both in the US and in the developing world."

AIDS Res Hum Retroviruses 2002;18:89-94.

Reuters Health Information 2002. � 2002 Reuters Ltd
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