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Effect of early chemoprophylaxis with co-trimoxazole on nutritional status evolution in HIV-1-infected adults in Abidjan, Côte d'Ivoire

Castetbon, Katiaa,b,c; Anglaret, Xavierc,d; Attia, Alainc,e; Toure, Siakac; Dakoury-Dogbo, Nicolec; Messou, Eugènec; N'Dri-Yoman, Thérèsec,e; Dabis, Françoisa,c; Salamon, Roger*; for the Cotrimo-CI Study Group

Clinical Science

Background: In sub-Saharan Africa, malnutrition is a major complication of HIV disease. Measuring accurately the nutritional benefits of a therapeutic intervention could be an easy-to-monitor secondary outcome.

Methods: Anthropometric data were analysed from patients participating in a placebo-controlled trial of co-trimoxazole prophylaxis in adults recruited at early stages of HIV-1 infection in Côte d'Ivoire (COTRIMO-CI ANRS 059 trial). Body mass index (BMI), arm muscle circumference (AMC) and percentage of fat mass (FM) were measured at baseline and quarterly during the follow up. Percentage of variation from the baseline value was compared between treatment groups and within the groups using Student t-test.

Results: An improvement of all anthropometric indicators was observed in the first 3 months of follow up in both treatment groups, significant in the co-trimoxazole group (P ≤ 0.0006) but not in the placebo group (P ≥ 0.06). In the co-trimoxazole group, this improvement was maintained for up to 24 months for BMI (P = 0.007), 21 months for AMC (P = 0.02) and only up to 12 months for FM (P = 0.04). The placebo group had a stable anthropometric status up to the end of the trial. Differences between treatment groups were significant for up to 15 months for BMI and AMC and 12 months for FM.

Conclusion: As co-trimoxazole prophylaxis is now recommended in Africa as part of a minimum package of care for HIV-infected symptomatic subjects, the short-term improvement of these anthropometric indicators in adults who start co-trimoxazole prophylaxis should be considered as an effective clinical outcome.

From aINSERM U.330, Université Victor Segalen Bordeaux 2, Bordeaux, France, the bCentre Institut de Recherche pour le Développement (IRD) de Petit-Bassam, the cProgramme PAC-CI, the dCentre de Diagnostic et de Recherche sur le SIDA et les Infections Opportunistes, Centre Hospitalier Universitaire (CHU) de Treichville and the eService de Gastro-Entérologie, CHU de Yopougon, Abidjan, Côte d'Ivoire. *See Appendix for study members.

Requests for reprints to Dr K. Castetbon, INSERM U.330 – Case 11, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33 076 Bordeaux, Cedex France.

Date of receipt: 23 May 2000;

revised: 13 September 2000; accepted: 13 February 2001.

Sponsorship: This study was supported by the Agence Nationale de Recherches sur le SIDA (ANRS, France), the French Ministry of Cooperation, and the Programme National de Lutte contre le SIDA, les MST et la Tuberculose (PNLS/MST/Tub) of within the PAC-CI Programme, and the ‘Agence Francophone pour l'Enseignement Supérieur et la Recherche’ (AUPELF-UREF, France).

Note: This study was presented in part at the XIth International Conference on AIDS/STDs in Africa, September 1999, Lusaka, Zambia [abstract 15BT5-1].

© 2001 Lippincott Williams & Wilkins, Inc.