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WHO, UNAIDS and UNICEF modify recommendations for cotrimoxazole prophylaxis in children
Joint WHO/UNAIDS/UNICEF statement on use of cotrimoxazole as prophylaxis in HIV exposed and HIV infected children


Statement on use of cotrimoxazole prophylaxis

22 November 2004 -- WHO, UNAIDS and UNICEF, guided by recent evidence, have agreed to modify as an interim the current recommendations(1) for cotrimoxazole prophylaxis in children. This is based upon recent trial data from Zambia (2).

These data and other new evidence will be reviewed in early 2005 by an expert committee convened to revise and update the recommendations for cotrimoxazole for adults and children. Cotrimoxazole remains important even with increasing access to ART, as it use can improve survival independently of specific HIV treatment. Current recommendations suggest it should be used before children require ARVs because it may even postpone the time at which ART needs to be started.

Prophylactic dosing with cotrimoxazole for HIV infected children with any sign or symptoms suggestive of HIV is a key intervention that should be offered as part of a basic package of care to reduce morbidity and mortality.

Cotrimoxazole prophylaxis is also a crucial potentially life saving intervention that should be given to all HIV exposed children born to HIV-infected mothers, in settings where HIV infection status cannot be reliably confirmed in the first 18 months of life.

Cotrimoxazole is a widely available antibiotic that is available in syrup and solid formulations at low-cost in most settings, including resource limited settings. It is highly effective for the treatment and prevention of Pneumocystis pneumonia. In HIV infected children it also offers protection against other infections, this remains important even with increasing access to ARV treatment.

Greater advocacy for the use of cotrimoxazole prophylaxis in children is urgently required.

:: Downloadable version of the statement [pdf 314kb]

Who should get cotrimoxazole:

How long should cotrimoxazole be given:

Cotrimoxazole is required to be taken as follows:

Under what circumstances should cotrimoxazole be discontinued:

What doses of cotrimoxazole should be used?

What follow-up is required?

Other operational issues

Drug supplies

Patient information

Patients need to be clear that while cotrimoxazole does not cure HIV, regular dosing is essential for protection of children from infections that are more common or more likely to occur in HIV infection. Cotrimoxazole does not replace the need for antiretroviral therapy.

Policy and programme information

Monitoring and evaluation

In order to monitor progress towards the delivery of comprehensive AIDS treatment, care and support, National programmes should assess the extent to which the range of HIV related care services are being implemented and set clear targets for children. Cotrimoxazole prophylaxis is an essential health intervention that needs to be included in child health services (including IMCI), PMTCT services, TB services and HIV ART treatment services (facility based and community based). Monitoring of progress towards achieving this should include:

References

1. Provisional WHO/Unaids Secretariat Recommendations Unaids On The Use Of Cotrimoxazole Prophylaxis In Adults And Children Living With HIV/Aids In Africa, accessible at: http://www.unaids.org/EN/other/functionalities/Search.asp

2. Co-trimoxazole as prophylaxis against opportunistic infections as HIV-infected Zambian children (CHAP): a chap a double-blind randomized placebo-controlled trial. Chintu C, GJ Bhat, AS Walker, V Mulenga, F Sinyinza, L Farrelly, Kagangson, A Zumla, Gillespie, A Nunn, D M Gibb Lancet 2004;364: 1865-71

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