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Low-cost drug gaining favor for use in HIV-infected children in poor countries

A new systematic review highlights strong results from a single study at the center of mounting support for worldwide use of the low-cost drug Bactrim to help HIV-infected children in poor countries.

The reviewers surveyed medical literature on the preventive use of Bactrim -- one of several brand names for the generic medicine cotrimoxazole -- for children to ward off common infections that can be deadly to a person whose immune system is weakened by HIV.

Dr. Kate Grimwade, with the Heart of England National Health Service foundation trust in Birmingham, led the review of the drug and found "a significant mortality benefit."

Grimwade's review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

To be included in the Cochrane findings, a study had to be a randomized clinical trial. Grimwade's search turned up only one trial that passed that litmus test: a study of 534 HIV-positive children in Zambia.

The study found 33 percent fewer deaths in the group of children who received cotrimoxazole versus the children who were not treated with the antibiotic. The children prescribed cotrimoxazole also were hospitalized less. Those positive results held true "across the board" for children in all age groups and in different stages of HIV illness, Grimwade said.

Every medication has side effects, and the trial did uncover some adverse reactions from cotrimoxazole. Still, Grimwade said the Zambian study shows that the drug is a safe precaution against opportunistic infections in HIV-positive children.

The new review is being released as health policy makers anticipate updated recommendations on cotrimoxazole from the World Health Organization. In May 2
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Contact: Kate Grimwade
katherine.grimwade@heartofengland.nhs.uk
Center for the Advancement of Health
24-Jan-2006


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