Transcript Co-trimoxazole (CTX) Meeting 8 February 2005

Cotrimoxazole Prophylaxis in HIV
positive individuals
Group A
Conclusions 1
•
Strong but still accumulating evidence that CTX is
beneficial in WHO stage 2, 3 or 4 or if CD4 <200.
– reduction of morbidity and mortality (mortality:
except for stage 2)
– slows HIV disease progression (Uganda)
• Useful also in areas with high CTX resistance
• CTX resistance in the lab may not exclude efficacy of
CTX as a prophylactic agent
Conclusions 2
•
•
•
•
Compliance rates
Safe
Cheap drug
Easy to administer
90%
2% side effects
Priority research questions ?
CTX in the context of ART
•
When do you stop CTX in patients who start ART.
– Until CD4 >200 x 3 months?
•
Is there an added benefit of CTX in patients who have access to CTX and ART at the same
time?
•
Are there criteria other than CD4s that could be used to decide when to stop CTX (with and
without ART)
– Clinical criteria?
– Arbitrary time period?
•
Efficacy in patients who are not yet eligible for ART ? Stage 1 and 2 (Cut off for starting CTX set
at 500 cells\ul. Too early?
– Too early: Implies too many patients on CTX: Major implications on workload, resistance
development and side effects?
•
Children: Efficacy and side effects
Priority research questions (2) ?
Tuberculosis.
• In HIV positive TB patients, when is the optimal time
to start cotrimoxazole (with and without ART)
Priority research questions (3)?
Efficacy
• Regional (Asia). Need for observational data on CTX
efficacy in Asia
• How long will CTX be effective (with and without
ART)
– Increasing resistance?
– Decreasing adherence?
Priority research questions (4)?
Implementation. Best delivery sites for CTX (TB, VCT,
ART, PMTCT clinics?
(CTX routine use in developing countries, particularly
sub-Saharan Africa has been minimal)
• Long term haematological side effects (with and
without ART)
What to do in the meantime ?
Follow WHO guidelines
• HIV positive TB patients
• Advanced HIV disease
• Concern on if CD4 500 cells\ul is not too early to start
CTX?