Cotrimoxazole prophylaxis for opportunistic infections in children with HIV infection.
BACKGROUND
The prevention and early treatment of infections are the mainstay of the medical management of the majority of children with HIV infection, who live in low income countries without access to antiretroviral drugs. Cotrimoxazole is cheap and effective against a wide range of organisms, including Pneumocystis carinii pneumonia (PCP) which is an important cause of death and illness in the first year of life. It is safe with relatively few side-effects. Diagnosis of HIV in children is complicated by the presence of maternal antibodies in early life and providing prophylaxis based initially on maternal status is one possible solution. However routine prophylactic treatment is difficult to deliver in low-resource settings, and could also lead to increased resistance to the drug.


OBJECTIVE
To assess the effects of routinely administered cotrimoxazole on death and illness episodes in children with HIV infection, and in infants of HIV infected mothers.


METHODS
We searched the Cochrane HIV/AIDS registry, MEDLINE, the Cochrane Controlled Trials Register, LILACS, AIDSLINE, AIDSTRIALS and AIDSDRUGS databases, and proceedings and abstracts from AIDS and TB conferences (search date July 2001). We checked reference lists of pertinent articles, and contacted pharmaceutical companies and experts in the field.


METHODS
Randomised or quasi randomised trials comparing routinely administered cotrimoxazole versus placebo or no treatment in children (age less than 13 years) with HIV infection, or children less than 18 months with HIV infected mothers.


METHODS
Two reviewers independently assessed trial eligibility and quality.


RESULTS
No studies were found that fulfilled the selection criteria.


CONCLUSIONS
No evidence from controlled trials was found of the effect of cotrimoxazole prophylaxis in HIV-infected children.
Grimwade
K
K
Hlabisa Hospital, Private Bag X5001, Hlabisa, Hlabisa, South Africa. kcg@iafrica.com
Swingler
G
G
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007223:Infant; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination