Article of the Month
“Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa”
Published in:
N Engl J Med 2017; 377:233-245.
Authors:
James Hakim, Victor Musiime, Alex J. Szubert, Jane Mallewa, Abraham Siika, Clara Agutu, Simon Walker, Sarah L. Pett, Mutsa Bwakura-Dangarembizi, Abbas Lugemwa, Symon Kaunda, Mercy Karoney, Godfrey Musoro, Sheila Kabahenda, Kusum Nathoo, Kathryn Maitland, Anna Griffiths, Margaret J. Thomason, Cissy Kityo, Peter Mugyenyi, Andrew J. Prendergast, A. Sarah Walker, and Diana M. Gibb, for the REALITY Trial Team.
Synopsis:
This article reports on the open-label, randomized REALITY trial, which compared an enhanced antimicrobial prophylaxis package to standard prophylaxis in individuals with a CD4 count <100 cells per cubic millimeter who were initiating antiretroviral treatment (ART). The enhanced prophylaxis package consisted of trimethoprim-sulfamethoxazole, plus at least 12 weeks of isoniazid-pyridoxine, 12 weeks of fluconazole, five days of azithromycin, and a single dose of albendazole. Standard prophylaxis was trimethoprim-sulfamethoxazole alone. The trial demonstrated a 27 percent reduction in all-cause mortality after 24 weeks and a 24 percent reduction in mortality after 48 weeks for participants receiving the enhanced prophylaxis package. Findings from this study have already been incorporated into the recently-released WHO guidelines for managing advanced HIV disease.
This article synopsis was written by Cassia Wells. Share your thoughts on this article or suggest an article for Journal Club by emailing her at caw2208@columbia.edu.
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