abdulhakeem
19-11-04, 08:49 PM
19 November 04
Andy Coghlan
A cheap antibiotic drug has almost halved the rate of AIDS-related deaths in African children, reveals a new study.
The antibiotic - co-trimoxazole - does not combat HIV but it prevents secondary infections which can kill HIV-positive children with weakened immunity.
The World Health Organization and UNICEF are so impressed with the study’s findings that they have already vowed to alter their standard guidelines to governments on how to tackle AIDS.
Researchers from the UK and Zambia gave the drug or a placebo to HIV-infected children aged one to 14 attending the University Teaching Hospital in Lusaka, Zambia. They then followed the treated children for 19 months.
Of the 541 children treated, 42% of the children who received the placebo died, compared with 28% of those on co-trimoxazole.
“That’s a 43% reduction in mortality over about 20 months,” says Diana Gibb of the UK Medical Research Council’s Clinical Trials Unit in London, who led the team.
“Although co-trimoxazole is not in the same league as antiretroviral drugs - which give a five-fold reduction in mortality - you could implement a programme of treatment fast and at a very basic health level,” she says.
Resistant bacteria
The idea is to give co-trimoxazole to all children diagnosed with AIDS-like symptoms. And at an annual cost of around $7 to $12 per child, co-trimoxazole is a bargain compared with the $200 to $300 for even the cheapest antiretrovirals.
As well as preventing bacterial infections, co-trimoxazole also appears to combat fungal, parasitic and malarial infections.
However, the decision to trial co-trimoxazole in this way was controversial because the study was deliberately held in an area where bacteria are resistant to co-trimoxazole, says Gibb.
The rationale was that if it could work there, it would work anywhere, but there were fears that widespread use of the antibiotic would make bacteria even more resistant.
So far, there has been no trace of increased resistance, but Gibb says the team will continue monitoring for it.
Fungal pneumonia
Gibb decided to try out co-trimoxazole after it emerged a decade ago as an effective treatment against fungal pneumonia in adult AIDS patients, as caused by the fungus Pneumocystis carinii.
Later, the fungal pneumonia turned out to be a leading cause of early death in babies born to mothers with HIV. And since the mid-1990s, prophylactic treatment of the newborn babies with co-trimoxazole has been shown to keep the fungus and other infections at bay.
The drug probably protected the Zambian children by stopping bacterial respiratory infections, believe researchers.
WHO first recommended giving co-trimoxazole to HIV-infected children in 2001. But children were treated only if they had specific symptoms, such as low CD4 blood cell counts.
In light of the new findings, WHO and UNICEF feel confident treating almost all suspected cases. “Any child with a whisper of HIV, give them co-trimoxazole,” says Siobhan Croxley, a paediatrics specialist at the WHO’s HIV-AIDS unit in Geneva, Switzerland.
“This is such an encouraging study because it gives us the evidence base behind what we’ve already been doing, and because it’s easy and feasible in resource-poor situations,” she says. Revised advice to governments will be issued in the coming months.
Journal reference: The Lancet (vol 364, p 1865)
http://www.newscientist.com/news/news.jsp?id=ns99996692
Andy Coghlan
A cheap antibiotic drug has almost halved the rate of AIDS-related deaths in African children, reveals a new study.
The antibiotic - co-trimoxazole - does not combat HIV but it prevents secondary infections which can kill HIV-positive children with weakened immunity.
The World Health Organization and UNICEF are so impressed with the study’s findings that they have already vowed to alter their standard guidelines to governments on how to tackle AIDS.
Researchers from the UK and Zambia gave the drug or a placebo to HIV-infected children aged one to 14 attending the University Teaching Hospital in Lusaka, Zambia. They then followed the treated children for 19 months.
Of the 541 children treated, 42% of the children who received the placebo died, compared with 28% of those on co-trimoxazole.
“That’s a 43% reduction in mortality over about 20 months,” says Diana Gibb of the UK Medical Research Council’s Clinical Trials Unit in London, who led the team.
“Although co-trimoxazole is not in the same league as antiretroviral drugs - which give a five-fold reduction in mortality - you could implement a programme of treatment fast and at a very basic health level,” she says.
Resistant bacteria
The idea is to give co-trimoxazole to all children diagnosed with AIDS-like symptoms. And at an annual cost of around $7 to $12 per child, co-trimoxazole is a bargain compared with the $200 to $300 for even the cheapest antiretrovirals.
As well as preventing bacterial infections, co-trimoxazole also appears to combat fungal, parasitic and malarial infections.
However, the decision to trial co-trimoxazole in this way was controversial because the study was deliberately held in an area where bacteria are resistant to co-trimoxazole, says Gibb.
The rationale was that if it could work there, it would work anywhere, but there were fears that widespread use of the antibiotic would make bacteria even more resistant.
So far, there has been no trace of increased resistance, but Gibb says the team will continue monitoring for it.
Fungal pneumonia
Gibb decided to try out co-trimoxazole after it emerged a decade ago as an effective treatment against fungal pneumonia in adult AIDS patients, as caused by the fungus Pneumocystis carinii.
Later, the fungal pneumonia turned out to be a leading cause of early death in babies born to mothers with HIV. And since the mid-1990s, prophylactic treatment of the newborn babies with co-trimoxazole has been shown to keep the fungus and other infections at bay.
The drug probably protected the Zambian children by stopping bacterial respiratory infections, believe researchers.
WHO first recommended giving co-trimoxazole to HIV-infected children in 2001. But children were treated only if they had specific symptoms, such as low CD4 blood cell counts.
In light of the new findings, WHO and UNICEF feel confident treating almost all suspected cases. “Any child with a whisper of HIV, give them co-trimoxazole,” says Siobhan Croxley, a paediatrics specialist at the WHO’s HIV-AIDS unit in Geneva, Switzerland.
“This is such an encouraging study because it gives us the evidence base behind what we’ve already been doing, and because it’s easy and feasible in resource-poor situations,” she says. Revised advice to governments will be issued in the coming months.
Journal reference: The Lancet (vol 364, p 1865)
http://www.newscientist.com/news/news.jsp?id=ns99996692