Hamel Mary J, Greene Carolyn, Chiller Tom, Ouma Peter, Polyak Christina, Otieno Kephas, Williamson John, Shi Ya Ping, Feikin Daniel R, Marston Barbara, Brooks John T, Poe Amanda, Zhou Zhiyong, Ochieng Benjamin, Mintz Eric, Slutsker Laurence
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Am J Trop Med Hyg. 2008 Sep;79(3):320-30.
We assessed the effect of daily cotrimoxazole, essential for HIV care, on development of antifolate-resistant Plasmodium falciparum, naso-pharyngeal Streptococcus pneumoniae (pneumococcus), and commensal Escherichia coli. HIV-positive subjects with CD4 cell count < 350 cells/muL (lower-CD4; N = 692) received cotrimoxazole; HIV-positive with CD4 cell count > or = 350 cells/muL (higher-CD4; N = 336) and HIV-negative subjects (N = 132) received multivitamins. Specimens were collected at baseline, 2 weeks, monthly, and at sick visits during 6 months of follow-up to compare changes in resistance, with higher-CD4 as referent. P. falciparum parasitemia incidence density was 16 and 156/100 person-years in lower-CD4 and higher-CD4, respectively (adjusted rate ratio [ARR] = 0.11; 95% confidence interval [CI] = 0.06-0.15; P < 0.001) and 97/100 person-years in HIV-negative subjects (ARR = 0.62; 95% CI = 0.44-0.86; P = 005). Incidence density of triple and quintuple dihydrofolate-reductase/dihydropteroate-synthetase mutations was 90% reduced in lower-CD4 compared with referent. Overall, cotrimoxazole non-susceptibility was high among isolated pneumococcus (92%) and E. coli (76%) and increased significantly in lower-CD4 subjects by Week 2 (P < 0.005). Daily cotrimoxazole prevented malaria and reduced incidence of antifolate-resistant P. falciparum but contributed to increased pneumococcus and commensal Escherichia coli resistance.
我们评估了艾滋病护理必需药物复方新诺明对耐叶酸恶性疟原虫、鼻咽部肺炎链球菌（肺炎球菌）和共生大肠杆菌生长的影响。CD4细胞计数<350个/微升的HIV阳性受试者（低CD4组；N = 692）接受复方新诺明治疗；CD4细胞计数≥350个/微升的HIV阳性受试者（高CD4组；N = 336）和HIV阴性受试者（N = 132）接受多种维生素治疗。在基线、2周、每月以及随访6个月期间的患病就诊时采集样本，以比较耐药性的变化，以高CD4组作为对照。恶性疟原虫血症发病率密度在低CD4组和高CD4组分别为16和156/100人年（调整率比[ARR]=0.11；95%置信区间[CI]=0.06 - 0.15；P<0.001），在HIV阴性受试者中为97/100人年（ARR = 0.62；95%CI = 0.44 - 0.86；P = 0.05）。与对照相比，低CD4组三重复和五重复二氢叶酸还原酶/二氢蝶酸合酶突变的发病率密度降低了90%。总体而言，分离出的肺炎球菌（92%）和大肠杆菌（76%）对复方新诺明的不敏感性较高，且在低CD4组受试者中到第2周时显著增加（P<0.005）。每日服用复方新诺明可预防疟疾并降低耐叶酸恶性疟原虫的发病率，但会导致肺炎球菌和共生大肠杆菌耐药性增加。
