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A Community-Based Study of the Incidence of Trimethoprim-Sulfamethoxazole-Preventable Infections in Malawian Adults Living With HIV

van Oosterhout, Joep J. G MD*; Laufer, Miriam K MD; Graham, Stephen M FRACP; Thumba, Feston Dip Clin Med§; Perez, M Arantza PhD, MSc; Chimbiya, Nelson Dip Lab§; Wilson, Lorna MSc; Chagomerana, Maganizo BSc§; Molyneux, Malcolm E FRCP; Zijlstra, Eduard E MD, PhD*; Taylor, Terrie E DO§¶; Plowe, Christopher V MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2005 - Volume 39 - Issue 5 - p 626-631
doi: 10.1097/01.qai.0000157007.58960.1b
Epidemiology and Social Science

The benefits of trimethoprim-sulfamethoxazole (TS) prophylaxis reported for persons living with HIV in Cote d'Ivoire are difficult to extrapolate to sub-Saharan African countries where bacterial resistance to TS is higher and cross-resistance between TS and sulfadoxine-pyrimethamine (SP) may impair SP efficacy for malaria treatment. We conducted a community-based cohort study to measure the incidence of potentially TS-preventable illnesses in Blantyre, Malawi. We found a high incidence of malaria, invasive bacterial infections, and probable bacterial pneumonias but low rates of Pneumocystis jiroveci pneumonia, isosporiasis, and Toxoplasma encephalitis. Most bacterial isolates were resistant to TS but sensitive to azithromycin, a possible alternative to TS. Clinical trials are needed to determine the role of TS or alternative regimens for prophylaxis against secondary infections among people living with HIV in sub-Saharan Africa. These should also assess benefit in patients receiving antiretroviral therapy.

From the *Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; †Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD; ‡Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; §Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi; ∥Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi; and ¶College of Osteopathic Medicine, Michigan State University, MI.

Received for publication June 17, 2004; accepted January 12, 2005.

Supported by National Institutes of Health grant R01AI47858.

Reprints: Christopher V. Plowe, Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, HSF 480, Baltimore, MD 21201 (e-mail: cplowe@medicine.umaryland.edu).

© 2005 Lippincott Williams & Wilkins, Inc.