Th e

NE W E NGL A ND JOU R NA L o f M E DICINE

Contin ued

Stopp ed

Figure 3. Changes in Laboratory and Anthropometric Variables. The between-group differences in changes from randomi ation to 1! wee"s #proph$la%is-stopped group minus proph$la%is-continued group& are shown. 'ertical lines indicate ,-. confidence inter/als.

A
Hemoglobi n

( g / d l ) R a n d o m i a t i o n ! r o m C h a n g e " e a n

0. 8

Global P=0.01 (ifference at w" 1!) *0.!+ #*0.+8 to *0.08&

0. 0

0. 1

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$nd that co)trimo*a+ole contin$es to

0. 0

'rovide 'rotection against ,acterial in!ections and malaria in s$,).aharan A!rica% des'ite good imm$ne reconstit$tion d$ring long)term AR#.
1 ! ! 1 1 8 2 ! , 0 1 0 8

*0 .! 0 +0 00 81

#ee$s since Randomi ation

% C&' ()Cell
*ercentage

( + ) R a n d o m i a t i o n ! r o m C h a n g

Global P=0.00! (ifference at w" 1!) *0.8 #*1.1 to *0.!&

#he increase in hos'itali+ations among the 'artici'ants (ho sto''ed receiving co) trimo*a) +ole (as evident earl and 'ersisted thro$gho$t !ollo()$'. It (as o,served in ,oth a co$ntr (here malaria is endemic /Uganda0 and a co$n) tr (here malaria is not endemic /1im,a,(e0. #he ris& o! malaria re2$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$ed to receive co) trimo*) a+ole% (as consistent (ith 'revio$s st$dies

sho(ing that co)trimo*a+ole 'revents 'arasit) " 3%43)45 emia and clinical malaria. A

randomi+ed
trial4" involving AR#)treated ad$lts in Uganda

similarl sho(ed increased ris&s o! malaria a!ter

*1 0 1 ! ! 1 +0 1 8 00 2 ! 81 , 0 1 0 8

co)trimo*a+ole (as discontin$ed. Altho$gh the

#ee$s since Randomi ation

'otential !or increased anti!olate resistance has

raised concerns a,o$t more (ides'read $se o!

co)trimo*a+ole%
46

C #eight)!or)Age
,core 0. 0-

most st$dies have not sho(n

44%47)48

an increase in resistance

9 (here high)level

resistance has emerged% anti!olates s$ch as s$l) !ado*ine and ' rimethamine still a''ear to ,e
e!!ective.
43

R a n d o 0. m 00 i a *0 t .0 i o n ! r o *0 m .1 0 C h a n g *0 e .1 " e a n

:$rthermore% g$idelines no( recom)

mend artemisinin),ased !irst)line antimalarial

treatment.
4;

In o$r st$d % 'artici'ants (ho sto''ed receiv)

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) mia% and meningitis < a !inding that is consis)
Global P=0.02 (ifference at w" 1!) *0.01 #*0.0, to 0.01&

tent (ith the ma=or red$ctions in ,acterial in!ec) tions o,served (ith co)trimo*a+ole in 're) AR#

*0 .! 0 0

1 !

! 1

+0

1 8

00

2 !

81

, 0

1 0 8

trials involving children

>%8

and ad$lts.

3%7

Co)tri)

#ee$s since Randomi ation

mo*a+ole 'rovided 'rotection against invasive

,acterial in!ection even in a 'atient 'o'$lation

6?

3 43G5 6 74( +2081 3467.9:G 6;3<;:= !) !011

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