Important note: Information in this article was accurate in October 2005. The state of the art may have changed since the publication date.
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AIDSWEEKLY Plus; Monday, October 31, 2005
Staff Medical Writers
According to recent research from France, "In 2000, WHO/UNAIDS recommended cotrimoxazole prophylaxis for persons at early stages of HIV infection (WHO stage >2) in sub-Saharan Africa." The cost-effectiveness of alternative strategies for initiation of cotrimoxazole in Cote d'lvoire" was assessed with an "HIV simulation model using clinical and cost data from a randomized trial of cotrimoxazole in HIV-infected adults."
"The study included HIV-infected patients in Cote d'lvoire, with median age 33 years. Thirty-four percent were classified as WHO stage 2, 59% as stage 3, and 7% as stage 4. The mean CD4 cell count was 331x106 cells/L.
"The interventions were no prophylaxis, clinical criteria-based cotrimoxazole initiation (early: WHO stage >2; late: WHO stage greater than or equal to3), CD4-based cotrimoxazole initiation (<500, <200, <50 x 106 CD4 cells/L). The outcome measures were life expectancy, lifetime costs, and incremental cost-effectiveness," investigators said.
"The most effective strategy, initiation of cotrimoxazole prophylaxis at WHO stage >2, increased undiscounted life expectancy by 5.2 months, discounted life expectancy by 4.4 months, and lifetime costs by US$ 60, compared with no prophylaxis.
"Delaying prophylaxis initiation until WHO stage >3 was less costly and less effective. All CD4-based strategies were dominated. The incremental cost-effectiveness of early versus late cotrimoxazole prophylaxis initiation was US$ 200/year of life gained," wrote Y. Yazdanpanah and colleagues at the Center Hospital Tourcoing.
Yazdanpanah continued, "Results were stable despite wide variations in plausible assumptions about bacterial resistance and the prophylaxis efficacy on cotrimoxazole-resistant strains."
"For HIV-infected adults in Cote d'lvoire, cotrimoxazole prophylaxis is reasonably cost-effective and most effective if initiated when WHO stage greater than or equal to2.
"Early cotrimoxazole prophylaxis will prevent complications prior to antiretroviral therapy initiation and should be considered an essential component of care for early HIV in sub-Saharan Africa," the authors concluded.
Yazdanpanah and colleagues published their study in AIDS (Clinical impact and cost-effectiveness of cotrimoxazole prophylaxis in patients with HIVAIDS in Cote d'Ivoire: a trial-based analysis. AIDS. 2005 Aug 12;19(12):1299-308.
For additional information, contact Y. Yazdanpanah, Center Hospital Tourcoing, Faculty Med Lille, Service University of Malad Infection & Voyageur, 135 Rue President Coty, BP 619, F-59208 Tourcoing, France.
Publisher contact information for the journal AIDS is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.
Keywords: Tourcoing, France, Cotrimoxazole Prophylaxis, HIV/AIDS, HAART, Complications Prevention, Sub-Saharan Africa.
This article was prepared by AIDS Weekly editors from staff and other reports.
Reference
Yazdanpanah Y, Losina E, Anglaret X, et al., "Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients with HIV/AIDS in Cote d'Ivoire: a trial-based analysis", AIDS. 2005 Aug 12;19(12):1299-308.
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