Effects of Cotrimoxazole on Hematologic Parameters in HIV-Infected Adults in a Community-Based Clinic in Entebbe, Uganda

Abstract

We and others have previously reported reduced mortality and malaria incidence with cotrimoxazole prophylaxis for HIV-1-infected adults in Uganda and elsewhere. This evidence has led to widespread implementation of cotrimoxazole prophylaxis for HIV-1-infected persons in sub-Saharan Africa. The World Health Organization (WHO) recommends that implementation at the country level should be carefully monitored and that this monitoring should evaluate rates of toxicity including hematologic toxicity through the measurement of blood cell counts every 6 months. Cotrimoxazole interferes with folate metabolism and there have been several reports of hematologic abnormalities associated with its use. These abnormalities could potentially worsen if cotrimoxazole is used in conjunction with myelosuppressive or antifolate drugs such as zidovudine. There is scanty evidence of these abnormalities associated with cotrimoxazole use in Uganda however. Cotrimoxazole prophylaxis was introduced in August 2000 in an open cohort of HIV-1-infected participants in EntebbeUganda. Here we report hematologic changes in participants before and after the introduction of cotrimoxazole. (excerpt)