WHO, UNICEF Urge Use of Low-Cost Antibiotic in HIV-Positive Children; Clinical Trial Stopped After Successful Results
The use of the low-cost antibiotic co-trimoxazole significantly reduced the death rate among HIV-positive children participating in a clinical trial in Zambia, according to a study published in the Nov. 20 issue of the Lancet, Reuters reports. The results of the study, which was stopped early because of the drug's success, have prompted scientists to recommend that co-trimoxazole be given to all HIV-positive children in developing countries, according to Reuters. Dr. Diana Gibb of Britain's Medical Research Council and colleagues administered the drug to 541 HIV-positive children ages one to 14 in Zambia (Reuters, 11/19). Half of the children were given a daily oral placebo and half were given co-trimoxazole, which costs less than 10 cents per day per child, AFP/Yahoo! News reports. When researchers followed up with the children after 19 months, 28% of the HIV-positive children in the co-trimoxazole group had died, while 42% of the children in the placebo group had died. The findings were "so remarkable" that the study was discontinued on "ethical grounds," and all of the children were put on a regimen of co-trimoxazole, according to AFP/Yahoo! News. The clinical reason for the success of the antibiotic is "unclear," but it is thought the drug fights pneumonia and tuberculosis bacteria that commonly affect people with immune systems that have been weakened by HIV, according to AFP/Yahoo! News (AFP/Yahoo! News, 11/19).
Gibb said that the trial results "can be generalized to a policy that could be applied universally to children with clinical features of HIV infection in Africa and elsewhere" (Reuters, 11/19). She added, "The results of this trial should provide an impetus to provide clinical care with co-trimoxazole prophylaxis and nutritional support, irrespective of levels of resistance to this drug" (BBC News, 11/19). Siobhan Crowley, a medical officer with the HIV/AIDS department of the World Health Organization, said that the study shows that developing countries should "step up" their use of the antibiotic for HIV-positive children, according to Reuters. "This is great news for children infected with HIV because this is something that we can very widely promote in very resource-limited settings," Crowley said, adding, "We feel that in the light of this we are able to revise our current recommendations to be a little bit more proactive and strongly advocate the use of co-trimoxazole" (Reuters, 11/19). UNICEF in a statement also praised the results of the trial, according to AFP/Yahoo! News. "UNICEF has been hopeful that co-trimoxazole could work to prolong children's lives, and now that we have the hard evidence, the challenge is to reach as many children as we can and immediately," a UNICEF spokesperson said, adding, "This cheap, widely available drug makes it possible to ensure that every child who needs it can get it" (AFP/Yahoo! News, 11/19).