Cheap drug could reduce mortality in HIV infected infants

A cheap prophylaxis drug, trimethoprim-sulphamethoxazole (TMP-SMX) cotrimoxazole, has shown to prevent the unnecessary death of many HIV infected infants who succumb to a deadly strain of pneumonia, according to University of Cape Town (UCT) researchers.

Pneumocystis carinii pneumonia (PCP), one of the major causes of hospitalisation and death in HIV-infected patients in developed countries before the introduction of anti-retroviral therapy, is also prevalent in Africa.

Cotrimoxazole is part of the Essential Drug List, which means it should be available at all state hospitals.

PCP was previously considered rare on this continent, but researchers have since established that a significant number of HIV-infected children are admitted to hospitals with PCP, where they often die.

A study by Dr Heather Zar and colleagues of the Department of Paediatrics and Child Health at UCT, found PCP in 10 percent of 151 HIV-infected children hospitalised with pneumonia in Cape Town’€™s Red Cross Children’€™s Hospital.

Moreover PCP was the AIDS-defining infection in 20 percent of those diagnosed as HIV positive at the time of hospital admission.

“It is important to note that PCP, which is associated with a high mortality, is a preventable infection. One solution would be for those who are seeing these kids in a primary health care setting to test children early for HIV infection so we can identify children with HIV early and start preventative therapy for this pneumonia,” Zar said.

She said the prophylaxis drug, cotrimoxazole should be administered to HIV-infected newborns from as young as six weeks. A week’€™s worth of cotrimoxazole for use in an infant as a prophylaxis is estimated to cost the state less that R1 per week.

But this does not automatically mean health care workers can prescribe the drug for use as a prophylaxis. Provinces are left to formulate their own policies on how drugs should be administered.

The national guidelines only indicated that cotrimoxazole could be prescribed as a prophylaxis for adult patients in the event of a previous PCP infection, or when the CD4 count drops below 200 or when there are signs of advanced immune deficiency. No mention is made of infants.

PCP is accompanied by coughing, high fever and difficulty in breathing. The infants, who are usually about six months old, have a fifty- percent chance of survival with death occurring within days.

Zar said post-mortem studies have found that PCP occurred in 31 percent of HIV-positive children younger than 15 months in Cote d’€™Ivoire and 16 percent of HIV-infected Zimbabwean children who died at home.

Two South African studies of children dying in intensive care units reported that PCP was common in the subset of patients that had postmortem lung biopsies, namely in 7 of 27 cases and 5 of 12 cases in Durban and Johannesburg respectively.

“This is a devastating pneumonia for children,” said Zar, who recently received an international research award in the United States for her work in diagnosing tuberculosis in children.

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