| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
We assessed the effect of daily cotrimoxazole, essential for HIV care, on development of antifolate-resistant Plasmodium falciparum, naso-pharyngeal Streptococcus pneumoniae (pneumococcus), and commensal Escherichia coli. HIV-positive subjects with CD4 cell count < 350 cells/µL (lower-CD4; N = 692) received cotrimoxazole; HIV-positive with CD4 cell count 
350 cells/µL (higher-CD4; N = 336) and HIV-negative subjects (N = 132) received multivitamins. Specimens were collected at baseline, 2 weeks, monthly, and at sick visits during 6 months of follow-up to compare changes in resistance, with higher-CD4 as referent. P. falciparum parasitemia incidence density was 16 and 156/100 person-years in lower-CD4 and higher-CD4, respectively (adjusted rate ratio [ARR] = 0.11; 95% confidence interval [CI] = 0.06–0.15; P < 0.001) and 97/100 person-years in HIV-negative subjects (ARR = 0.62; 95% CI = 0.44–0.86; P = 005). Incidence density of triple and quintuple dihydrofolate-reductase/dihydropteroate-synthetase mutations was 90% reduced in lower-CD4 compared with referent. Overall, cotrimoxazole non-susceptibility was high among isolated pneumococcus (92%) and E. coli (76%) and increased significantly in lower-CD4 subjects by Week 2 (P < 0.005). Daily cotrimoxazole prevented malaria and reduced incidence of antifolate-resistant P. falciparum but contributed to increased pneumococcus and commensal Escherichia coli resistance.
Received November 23, 2007. Accepted for publication May 30, 2008.
Acknowledgments: We thank the subjects who participated in this study, the CTX clinical staff who provided caring support to the subjects, including Monica Aluoch Ochieng, Mary Owino, Ida Ouma, Agnes Owiti, Grace Otom, and Mary Caesar, the scientific and laboratory team including Ananias Escalante and Venkatachalam Udhayakumar, who provided oversight and technical expertise for the molecular resistance laboratory work, and Cheryl Bopp, Richard R. Facklam, Mary Omwalo, Geoffrey Jagero, Dickens Olang, Lata Kumar, and Ira Goldman. We also thank Carolyn Wright and Kathleen Wannemuehler who contributed to data management and cleaning, Anne Schuchat for technical guidance, and John Vulule for support.
Financial support: Funding was provided for by the Opportunistic Infections Working Group, Centers for Disease Control and Prevention, and the Antimicrobial Resistance Working Group, Centers for Disease Control and Prevention. AAE was supported by NIH Grant R01 GM60740.
Disclosure: The authors do not have a commercial or other association that might pose a conflict of interest. The funding organizations had no role in the design and conduct of the study; in the collection, analysis and interpretation of the data; or in the preparation, review, or approval of the manuscript.
* Address correspondence to Mary J. Hamel, Unit 64112, APO 09831. E-mail: mhamel{at}ke.cdc.gov
Authors’ addresses: Mary J. Hamel, KEMRI/CDC Research Station, Unit 64112, APO 09831, Tel: 254-722-772-616, Fax: 254-57-20-22981, E-mail: mhamel{at}ke.cdc.gov. Carolyn Greene, Bureau of Public Health Training, NYC Department of Health and Mental Hygiene, 2 Lafayette Street, New York, NY 10007. Tom Chiller, John Williamson, Barbara Marston, John T. Brooks, Amanda Poe, Zhiyong Zhou, Ya Ping Shi, Eric Mintz, and Laurence Slutsker, Center for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333. Peter Ouma, Kephas Otieno, and Benjamin Ochieng, Box 1678, Kisuma, Kenya. Christina Polyak, 1513 Belt Street, Baltimore, MD 21202.
This article has been cited by other articles:
|
|
 |
|
  D. H. Hamer and C. J. Gill Balancing Individual Benefit Against Public Health Risk: The Impact of Cotrimoxazole Prophylaxis in HIV-infected Patients on Antimicrobial Resistance Am J Trop Med Hyg, September 1, 2008; 79(3): 299 - 300. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
