title: A community-based study of the incidence of trimethoprim-sulfamethoxazole-preventable infections in Malawian adults living with HIV.
abstract: 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.
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Joep J G
authors.initials: JJ
authors.lastname: van Oosterhout
authors.forename: Miriam K
authors.initials: MK
authors.lastname: Laufer
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Graham
authors.forename: Feston
authors.initials: F
authors.lastname: Thumba
authors.forename: M Arantza
authors.initials: MA
authors.lastname: Perez
authors.forename: Nelson
authors.initials: N
authors.lastname: Chimbiya
authors.forename: Lorna
authors.initials: L
authors.lastname: Wilson
authors.forename: Maganizo
authors.initials: M
authors.lastname: Chagomerana
authors.forename: Malcolm E
authors.initials: ME
authors.lastname: Molyneux
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Zijlstra
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Taylor
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Plowe
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D001424:Bacterial Infections / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008288:Malaria / Q000517:prevention & control; D008295:Malawi; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D016781:Toxoplasmosis, Cerebral / Q000517:prevention & control; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017963:Azithromycin