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Cotrimoxazole
Prophylaxis for TB Effectively Reduces Adult Death Rates in Rural
South Africa
Adults
with dual tuberculosis
(TB) and HIV infection have a poor outcome. Studies in
West Africa suggest that cotrimoxazole
prophylaxis may reduce this mortality.
The
study objective was to evaluate the effectiveness of cotrimoxazole
in reducing mortality in adults
with active TB, irrespective of HIV status, in a high HIV
prevalence setting in a cohort study using historical
controls.
Adults
treated for TB between 1998 and 2000 were traced and vital status
at 6 months ascertained (2004: control group).
All
adults starting treatment for TB between June 2001 and June 2002
were offered cotrimoxazole prophylaxis 960 mg once daily for 6 months
during TB treatment irrespective of HIV status (1321: intervention
group). Mortality, adverse reactions and adherence were compared
between intervention and control groups.
Results
HIV
seroprevalence in patients with TB at the start of the intervention
was estimated to be 78%.
Mortality
at 6 months was 29% lower in the group given cotrimoxazole than
in the control group.
The
number needed to treat to prevent one death during the period of
TB treatment was 24. The benefit was seen across all types of TB
but was only evident in new patients; patients being retreated had
similar outcomes in both groups.
Adverse
events were infrequent and minor, with only two participants having
treatment stopped for this reason.
Conclusion
The
authors conclude, “Cotrimoxazole prophylaxis for all adults with
TB, irrespective of HIV status, in an area of high HIV seroprevalence
may be a feasible, safe and effective way to reduce mortality for
the duration of treatment.”
O2/09/05
Reference
K
Grimwade and others. Effectiveness of cotrimoxazole prophylaxis
on mortality in adults with tuberculosis in rural South Africa.
AIDS 19(2): 163–168. January 28, 2005.
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