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T h

e NE W E NGL A ND JOU R NA L o f M E DICINE

Continued

Stopped

Figure 3. Changes in Laboratory andAnthropometric

Variables.AHemoglobi

n The between-group differences in changes from

ran-

(g

/dl)Randomia

tion!romChange"ean

0.8

GlobalP=0.01

domiation to 1! wee"s #proph$la%is-stoppedgroup

minus proph$la%is-continued group& are shown.'erti-

(ifference at w" 1!) *0.!+ #*0.+8 to

*0.08&

cal lines indicate , confidence inter/als.0.

0. monia. Once children in those locations have

good recover o! CD" # cells d$ring AR#% the

ris& o! o''ort$nistic in!ections is lo( and

cessa)

0.!

tion o! co)trimo*a+ole a''ears to ,e sa!e.-o()ever% (e !o$nd that co)trimo*a+ole contin$esto

0.0 'rovide 'rotection against ,acterial in!ections

and malaria in s$,)aharan A!rica% des'itegood

imm$ne reconstit$tion d$ring long)term AR#.*0.!

#he increase in hos'itali+ations among the01!

! +

8 0

2! 8

,

108

#ee$s since

Randomiation

'artici'ants (ho sto''ed receiving co)

trimo*a)

+ole (as evident earl and 'ersisted

thro$gho$t% C&' Cell*ercentage !ollo()$'. It (as o,served in ,oth a co$ntr

(+)Randomiation!ro

mChang

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(here malaria is endemic /Uganda0 and aco$n)

tr (here malaria is not endemic /1im,a,(e0.(ifference at w" 1!) *0.8 #*1. to*0.!&

#he ris& o! malaria re2$iring hos'itali+ation%

! (hich (as t(ice as high among 'artici'ants

(ho sto''ed receiving co)trimo*a+ole as it(as

among those (ho contin$ed to receive co)

trimo*)

1 a+ole% (as consistent (ith 'revio$s st$dies

sho(ing that co)trimo*a+ole 'revents 'arasit)0 emia

"and clinical malaria.

3%43)45A

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randomi+ed

trial4"

involving AR#)treated ad$lts in Uganda

similarl sho(ed increased ris&s o! malariaa!ter

*1 co)trimo*a+ole (as discontin$ed. Altho$gh the

01!

! +

8 0

2!

8,

108 'otential !or increased anti!olate resistance has

#ee$s since

Randomiation raised concerns a,o$t more (ides'read $se o!

co)trimo*a+ole%46

most st$dies have not sho(nC #eight!orAge ,core an increase in resistance

44%47)489 (here high)level

0.0 resistance has emerged% anti!olates s$ch as

s$l)Randomiation!romChange"ea

n

!ado*ine and 'rimethamine still a''ear to ,e

0.00 e!!ective.

43:$rthermore% g$idelines no( recom)

mend artemisinin),ased !irst)line antimalarial*0

.0 treatment.4;

In o$r st$d% 'artici'ants (ho sto''edreceiv)

*0.10

ing co)trimo*a+ole also had an increase in the

n$m,er o! hos'itali+ations !or in!ection other

than malaria% 'artic$larl 'ne$monia% se'tice)*0.1

mia% and meningitis < a !inding that isconsis)

GlobalP=0.02

tent (ith the ma=or red$ctions in ,acterialin!ec)(ifference at w" 1!) *0.0 #*0.0, to0.01&

tions o,served (ith co)trimo*a+ole in 're)

AR#

*0.!0

01!

! +

8 0

2!

8,

108 trials involving children

>%8and ad$lts.

3%7Co)tri)

#ee$s since

Randomiation

mo*a+ole 'rovided 'rotection against

invasive

,acterial in!ection even in a 'atient 'o'$lation

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