ICTM logo
Further results from the CHAP study

22 January 2007

Results on the effect of cotrimoxazole on causes of death, hospital admissions and antibiotic use in HIV-infected children from the CHAP trial have been published in the January edition of AIDS.

CHAP was a randomised controlled trial conducted by the MRC CTU and University Teaching Hospital, Lusaka, Zambia. It compared cotrimoxazole prophylaxis with placebo in HIV-infected children in Zambia, where background bacterial resistance to cotrimoxazole is high. Results from the trial have previously been reported.

Cotrimoxazole prophylaxis reduces morbidity and mortality in HIV-1-infected children, but mechanisms for these benefits are unclear. This new publication compares causes of mortality and hospital admissions, and antibiotic use between randomised groups.

Of 534 children, 186 died and 166 had one or more hospital admissions not ending in death. Cotrimoxazole prophylaxis was associated with lower mortality, both outside hospital (P = 0.01) and following hospital admission (P = 0.005), with the largest excess in hospital deaths and admissions in the placebo group from respiratory infections.

The authors conclude that "cotrimoxazole prophylaxis appears to mainly reduce death and hospital admissions from respiratory infections, supported further by lower rates of prescribing additional antibiotics in the cotrimoxazole group. As such infections occur at high CD4 cell counts and are common in Africa, the role of continuing cotrimoxazole prophylaxis after starting antiretroviral therapy requires investigation".

Reference: Mulenga V, Ford D, Walker AS, Mwenya D, Mwansa J, Sinyinza F, Lishimpi K, Nunn A, Gillespie S, Zumla A, Chintu C, Gibb DM; the CHAP Trial Team. Effect of cotrimoxazole on causes of death, hospital admissions and antibiotic use in HIV-infected children. AIDS 2007 Jan 2;21(1):77-84.