Background In sub-Saharan Africa, various bacterial diseases occur before pneumocystosis or toxoplasmosis in the course of HIV-1 infection, and are major causes of morbidity and mortality.
We did a randomised, double blind, placebo-controlled clinical trial at community-health centres in Abidjan, Cote d'Ivoire, to assess the efficacy of trimethoprim-sulphamethoxazole (co-trimox azole) chemoprophylaxis at early stages of HIV-1 infection.
Method 843 HIV-infected patients were screened and 545 enrolled in the study.
Eligible adults (with HIV-1 or HIV-1 and HIV-2 dual seropositivity at stages 2 or 3 of the WHO staging system) received co-trimox azole chemoprophylaxis (trimethoprim 160 mg, sulphamethoxazole 800 mg) daily or a matching placebo.
The primary outcome was the occurrence of severe clinical events, defined as death or hospital admission irrespective of the cause.
Analyses were by intention to treat.
Findings Four of the randomised patients were excluded (positive for HIV-2 only). 120 severe events occurred among 271 patients in the co-trimox azole group and 198 among 270 in the placebo group.
Significantly fewer patients in the co-trimox azole group than in the placebo group had at least one severe event (84 vs 124) ; the probability of remaining free of severe events was 63.7% versus 45.8% (hazard ratio 0.57 [95% Cl 0.43-0.75], p=0.0001) and the benefit was apparent in all subgroups of initial CD4-cell count. (...)
Mots-clés Pascal : SIDA, Virose, Infection, Virus HIV1, Virus immunodéficience humaine, Lentivirus, Retroviridae, Virus, Essai thérapeutique contrôlé, Triméthoprime, Sulfaméthoxazole, Randomisation, Chimioprophylaxie, Précoce, Evaluation, Côte d'Ivoire, Afrique, Homme, Immunopathologie, Immunodéficit, Antiinfectieux, Prévention
Mots-clés Pascal anglais : AIDS, Viral disease, Infection, HIV-1 virus, Human immunodeficiency virus, Lentivirus, Retroviridae, Virus, Controlled therapeutic trial, Trimethoprim, Sulfamethoxazole, Randomization, Chemoprophylaxis, Early, Evaluation, Ivory Coast, Africa, Human, Immunopathology, Immune deficiency, Antiinfectious, Prevention
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0270009
Code Inist : 002B05C02D. Création : 16/11/1999.