EFFICACY OF COTRIMOXAZOLE IN PREVENTION OF OPPORTUNISTIC INFECTIONS AMONG HIV INFECTED PATIENTS IN HO CHI MINH CITY

Nguyen Huu Chi ¹ , Vo Thi Tuyet Nhung ² , Maryvonne Maynart ² , N.V Ngai ³ , N.T.K.Cuc ¹ ,
P.V.Hung ⁵ , Corine Chazallon ⁵ , D.T.M.Ha ⁴ , H.V.K.Binh ⁴ , T.X.Lien ² , J.Y.Follezou ⁶ .

¹ Centre for Tropical Medicine in Ho Chi Minh City, ² Pasteur Institute in Ho Chi Minh City,

³ Centre for Rehabilitation Binh Trieu in Ho Chi Minh City, ⁴ Centre for Preventive Medicine in Ho Chi Minh City,

⁵ Inserm SC10, Paris, ⁶ University of Paris VI

Introduction

HIV epidemic has increased rapidly in Vietnam but use of antiretroviral therapy (ART) is still low, focus to post exposure prophylaxis and mother to child transmission. Preventing OIs for HIV-infected people by cotrimoxazole was shown to be effective in decreasing morbidity and mortality. However, adherence plays an important role in the outcome of therapy. In order to carry on an ART trial, a pilot program was conducted to prevent OIs infections.

Objectives: To evaluate efficaya of cotrimoxazole in prevention of OIs among HIV infected patients during 6 months in HCMC.

Method: A longitudinal study was conducted among HIV infected patients with CD4<500 cell/mm³ attending Centre for Tropical Medicine and Binh Trieu Hospital in Ho Chi Minh City during 2001-2002. Study subjects received 960 mg cotrimoxazole daily and treatment for OIs if needed. Socio-demographics indicators, blood cells count, CD4 cells count were collected in a standard questionnaire. HIV related and non-HIV related symptoms, adverse events were collected in visit forms monthly. Adherence was calculated as the cover of at least 80% of the 6-months follow up period.

Results: 103 patients were included in which 82.5% are male. Mean of age was 35.6± 10.8 years. Injecting drug was the main HIV transmission mode (73.3%) in which 48.6% were active IV drug users. Mean of CD4 cell count was 252±144.1 cells/mm³. Mean of follow up was 92.3 days ± 77.5 days and 45 of 103 patients (43.7 %) were considered as adherent. Rate of adverse events was low, about 4.2/10000 person-days, only 2 patients interrupted treatment due to degree 3 cutaneous allergy.

Male, single, IDU transmission mode and low count of CD4 cells were associated with lower adherence. Results of logistic regression analysis showed that heterosexual transmission and CD4 >50 cell/mm³ were independently associated with greater adherence (OR = 4.3 [1.5-12.3] and 7.4 [1.3-42.5] respectively).

Conclusion

Efficacy and tolerance of cotrimoxazole to OIs treatment is acceptable but adherence was low in our pilot program. Even if the efficacy of ART therapy could increase adherence, more psychosocial supports and implication of a multidisciplinary healthcare team are needed. Directly administered antiretroviral therapy (DAAT) and once- daily regimen can be good alternatives to begin ART and improve drug adherence in this IDU population.