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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$ntr
(+)Randomiation!ro
mChang
+GlobalP=0.00!
(here malaria is endemic /Uganda0 and aco$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
6? 3 43G5 6 74( +201 3467.9:G 6;3
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