AEGiS-15IAC: Granulocytopenia associated with cotrimoxazole prophylaxis in a community based clinic, Entebbe, Uganda.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Granulocytopenia associated with cotrimoxazole prophylaxis in a community based clinic, Entebbe, Uganda.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoPeB3148)

Watera C, Todd J, Brink A, Whitworth J, Miiro G, Mutonyi G, Muwonge R, Nakiyingi J, Grosskurth H
London School of Tropical Medicine and Hygiene, London, United Kingdom

BACKGROUND: Opportunistic infection (OI) prophylaxis remains important care for symptomatic HIV positive adults because of limited access to ARVs in Uganda. This is usually continued in patients on ARVs with advanced disease until there is immunological improvement. For long term cotrimoxazole prophylaxis, monitoring for subclinical toxicity such as bone marrow suppression is important.

METHODS: Cotrimoxazole prophylaxis was introduced in a cohort of HIV infected adults in Entebbe from August 2000. Total white cell and granulocyte counts were used to monitor bone marrow toxicity. For analysis, we considered participants who had 12 months follow up before and 12 months after the intervention. The mean change in these parameters was compared before and after the intervention.

RESULTS: 364 (48%) participants had 12 months follow up before and after cotrimoxazole prophylaxis. The mean granulocyte count fell significantly more during the intervention (3.05 to 2.43 x 109/L: mean change -0.62 x 109/L) compared to the pre-intervention period (3.15 to 3.13 x 109/L: mean change -0.02 x 109/L): p<0.001. The mean total white cell count fell significantly more during the intervention (mean change: -0.88 x 109/L) compared to the pre-intervention period (mean change +0.08 x 109/L): p<0.001). There was no statistical difference for dangerously low levels of granulocytes (<1x109/L) or total white cells (<2x109/L) in the two periods (p=0.2).

CONCLUSIONS: Prophylactic cotrimoxazole use in HIV infected adults in Uganda was associated with granulocytopenia. Regular monitoring for haematological toxicity is recommended for individuals on long term cotrimoxazole therapy.

Keywords: AEGIS, Trimethoprim-Sulfamethoxazole Combination, Acquired Immunodeficiency Syndrome, Agranulocytosis, HIV Seropositivity, Antiretroviral Therapy, Highly Active, Uganda, Drug Therapy, Combination, Adult, Humans, prevention & control, therapy, drug therapy

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MoPeB3148