Co-trimoxazole Therapy – One Step Closer towards Better AIDS Treatment
AIDS (Acquired Immunodeficiency Syndrome) – who does not want its cure? The worldwide consensus is to achieve it for the improvement of human health. Scientists have been trying since long to acquire this. Have they been successful? Yes, but how far? Let’s find it out.
AIDS is considered as one of the deadliest diseases. Being a viral infection, it was first discovered in 1981 and is now progressing rapidly, adding to the worldwide mortality. Antiretroviral therapy (ART) is directed against it, which has shown promising results in recent years. World Health Organization (WHO) guidelines indicate the use of ART in people having CD4 T-cell count less than 500/µl (especially in those having it below 350/µl) or in those who are symptomatic regardless of CD4 count. (1)
United States has also extended these guidelines for those people who have been diagnosed positive for Human Immunodeficiency Virus (HIV) regardless of CD4 count or symptoms. (2) This, along with treating opportunistic infections that develop as a part and parcel of AIDS, help in decreasing mortality due to HIV and improving health care. But there has been a breakthrough in the treatment regimen for AIDs recently. Scientists have discovered that co-trimoxazole prophylaxis for more than 96 weeks of ART helps in reducing the disease burden.
Co-trimoxazole is an antibiotic consisting of 1 part trimethoprime with 5 parts of sulfamethoxazole and has bactericidal action. A study very recently published in New England Journal of Medicine demonstrated the effect of co-trimoxazole after 96 weeks’ treatment of ART in reducing mortality in HIV patients. It was conducted in sub-Saharan Africa (Uganda and Zimbabwe) which is the most endemic area of AIDS with 69% of the global HIV infected patients living here. Women account for about 60% of the cases here.
The study was directed to compare the effects of prophylactic co-trimoxazole in HIV infected patients in a randomized trial in two groups, one in which patients continued having prophylaxis treatment with the forth mentioned drug and another group in which the prophylaxis treatment was stopped. The study showed that in contrast with the patients who continued with co-trimoxazole therapy, those who had abandoned it had more frequent hospitalizations mainly due to malaria and other infections including pneumonia, sepsis, diarrhea and meningitis and an increased death rate. Parasitemia was also higher in this group. Adverse events like anemia also occurred more.
But on the other hand, co-trimoxazole prophylaxis continued group was more fortunate in maintaining better health with an increase in the hemoglobin formation and CD4 T-cell count. However, the other group showed a more rapid increase in white blood cell count (WBC) and neutrophils, but a slower increase in CD4 count. Neutrophils and WBC count rose very slowly in the prophylaxis continuing group, probably due to myelosuppressive effects of the prophylactic drug. One disadvantage in the group continuing with prophylaxis was however, more cases of tuberculosis. The efficacy of co-trimoxazole remained unaltered for age, sex, health center or country and was maximum for patients having CD4 T-cell count 30% or more. (33)
Overall, co-trimoxazole proved to be a promising drug in reducing HIV induced mortality and also helps to improve the quality of life of such patients. Its long trial has been successful and we can anticipate its use for treatment of HIV soon in future. AIDS is a deadly disease which in spite of having promising treatment, is still considered absolutely fatal by common man.
The severe deteriorating condition, opportunistic infections, long term medications and their adverse effects are all disliked by the patient. AIDS also brings about with it psychological trauma for the patient and the closed ones alike. A new discovery in the treatment plan of AIDS will therefore be very much welcomed with high hopes.
1. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. World Health Organization. 2013. pp. 28–30.
2. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services. Feb 12, 2013. p. i. Retrieved 3 January 2014.
3. Bwakura-Dangarembizi M, Kendall L, Bakeera-Kitaka S, Nahirya-Ntege P, Keishanyu R, Nathoo K, Spyer MJ, Kekitiinwa A, Lutaakome J, Mhute T, Kasirye P, Munderi P, Musiime V, Gibb DM, Walker AS, Prendergast AJ; Antiretroviral Research for Watoto (ARROW) Trial Team. A randomized trial of prolonged co-trimoxazole in HIV-infected children in Africa. N Engl J Med. 2014 Jan 2;370(1):41-53.
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