Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial

Trials of a low-cost antibiotic drug with HIV infected children in Zambia have been stopped early when it became clear that the drug nearly halved the mortality rate compared with placebo.

The researchers argue that the co-trimoxazole drug should be given to all children with HIV in developing countries to help reduce illness and death from opportunistic infections such as pneumonia.

The trials found that after a follow-up of 19 months, 28% of children in the co-trimoxazole group and 42% in the placebo group had died. This benefit applied in children followed up beyond 12 months and across all ages and baseline CD4 counts.

The results suggest that children of all ages with clinical features of HIV infection should receive co-trimoxazole prophylaxis in resource-poor settings. Economic analyses are planned to assess the costs and benefits of such an approach, which could be done in the community. Since antiretroviral treatment is being introduced more widely in Africa, many countries are considering how to provide care and such treatment to HIV-infected children as well as to adults. The results of this trial should provide an impetus to provide clinical care with co-trimoxazole prophylaxis and nutritional support, irrespective of levels of resistance to this drug. Whether it would continue to add benefit to children also taking antiretroviral therapy in areas of high background rates of infection remains to be seen.

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