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

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 QUESTION: In HIV-1 infected African patients being treated for tuberculosis, does the addition of trimethoprim sulfamethoxazole (co-trimoxazole) prophylaxis decrease morbidity and mortality?


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


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


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 >1.1×109/l, platelet count >100×109/l, serum alanine aminotransferase level <2.5 times the upper limit of normal, and serum creatinine concentration <150 g/l). Exclusion criteria were …

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  • Sources of funding: Centers for Disease Control and Prevention; Rockefeller Foundation; Roche African Research Foundation.

  • For correspondence: Dr S Wiktor, Projet RETRO-CI, 01 BP 1712, 01 Abidjan, Côte d'Ivoire. Fax +225 404 639 4268.

  • * See glossary.