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Trimethoprim sulfamethoxazole decreased morbidity and mortality in HIV-1 infected patients with tuberculosis

Design
Randomised (allocation concealed^*), blinded (clinicians and patients),^* placebo controlled trial with median 10.5 month follow up.

Setting
4 outpatient tuberculosis treatment centres in Abidjan, Côte d'Ivoire.

Patients
771 patients (mean age 32 y, 60% men) who had sputum smears positive for tuberculosis, were HIV-1 positive, or dually reactive for HIV-1 and HIV-2, and met laboratory eligibility criteria (haemoglobin level 70 g/l, granulocyte count >1.1x10⁹/l, platelet count >100x10⁹/l, serum alanine aminotransferase level <2.5 times the upper limit of normal, and serum creatinine concentration <150 g/l). Exclusion criteria were positivity for HIV-2, pregnancy, previously treated tuberculosis, allergy to co-trimoxazole, or receipt of co-trimoxazole to prevent recurrent toxoplasmosis. 764 patients (99%) were included in the analysis.

Intervention
Patients were allocated to 1 tablet daily of trimethoprim, 160 mg, and sulfamethoxazole, 800 mg (n=386), or placebo (n=385). All patients received tuberculosis medication for 6 months.

Main outcome measures
Death and 1 hospitalisation.

Main results
85% . . . [Full text of this article]

Manjula Datta, MD, Dch, MSc

Tamil Nadu Dr M G R Medical University Chennai, Tamil Nadu, India