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Cotrimoxazole Prophylaxis in HIV positive individuals Group A

Cotrimoxazole Prophylaxis in HIV positive individuals Group A. Conclusions 1. Strong but still accumulating evidence that CTX is beneficial in WHO stage 2, 3 or 4 or if CD4 <200. reduction of morbidity and mortality (mortality: except for stage 2) slows HIV disease progression (Uganda)

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Cotrimoxazole Prophylaxis in HIV positive individuals Group A

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  1. Cotrimoxazole Prophylaxis in HIV positive individualsGroup A

  2. Conclusions 1 • Strong but still accumulating evidence that CTX is beneficial in WHO stage 2, 3 or 4 or if CD4 <200. • reduction of morbidity and mortality (mortality: except for stage 2) • slows HIV disease progression (Uganda) • Useful also in areas with high CTX resistance • CTX resistance in the lab may not exclude efficacy of CTX as a prophylactic agent

  3. Conclusions 2 • Compliance rates 90% • Safe 2% side effects • Cheap drug • Easy to administer

  4. Priority research questions ? CTX in the context of ART • When do you stop CTX in patients who start ART. • Until CD4 >200 x 3 months? • Is there an added benefit of CTX in patients who have access to CTX and ART at the same time? • Are there criteria other than CD4s that could be used to decide when to stop CTX (with and without ART) • Clinical criteria? • Arbitrary time period? • Efficacy in patients who are not yet eligible for ART ? Stage 1 and 2 (Cut off for starting CTX set at 500 cells\ul. Too early? • Too early: Implies too many patients on CTX: Major implications on workload, resistance development and side effects? • Children: Efficacy and side effects

  5. Priority research questions (2) ? Tuberculosis. • In HIV positive TB patients, when is the optimal time to start cotrimoxazole (with and without ART)

  6. Priority research questions (3)? Efficacy • Regional (Asia). Need for observational data on CTX efficacy in Asia • How long will CTX be effective (with and without ART) • Increasing resistance? • Decreasing adherence?

  7. Priority research questions (4)? Implementation. Best delivery sites for CTX (TB, VCT, ART, PMTCT clinics? (CTX routine use in developing countries, particularly sub-Saharan Africa has been minimal) • Long term haematological side effects (with and without ART)

  8. What to do in the meantime ? Follow WHO guidelines • HIV positive TB patients • Advanced HIV disease • Concern on if CD4 500 cells\ul is not too early to start CTX?

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