Low-cost antibiotic co-trimoxazole should be given to all children with HIV in developing countries

Results of a randomised trial in this week’s issue of THE LANCET highlight how the low-cost antibiotic co-trimoxazole should be given to all children with HIV in developing countries to help reduce illness and death from opportunistic infections such as pneumonia.

The trial was stopped early when it became obvious that co-trimoxazole treatment nearly halved the mortality rate compared with placebo.

Antibiotic resistance limits the efficacy of drugs such as co-trimoxazole; no trials of this drug for HIV-infected adults or children have been done in areas with high levels of bacterial resistance to co-trimoxazole.

Diana Gibb (Medical Research Council, UK) and colleagues studied 541 children with HIV symptoms aged between 1 and 14 years living in Zambia (a country where drug resistance to common antibiotics is widespread). Half the children were given daily co-trimoxazole, the other half placebo, and average follow-up was done 19 months later. Around a quarter of children given Co-trimoxazole compared with over 40% of children given placebo had died at follow-up.

Dr Gibb comments: “We believe that our results can be generalised to a policy that could be applied universally to children with clinical features of HIV infection in Africa: all should receive co-trimoxazole prophylaxis irrespective of age and CD4 count. Since antiretroviral treatment is being introduced more widely in Africa, many countries are considering how to provide care and such treatment to HIV-infected children as well as to adults. The results of this trial should provide an impetus to provide clinical care with co-trimoxazole prophylaxis and nutritional support, irrespective of levels of resistance to this drug.”