Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa

by James Hakim, Victor Musiime, Alex J. Szubert et al.
N Engl J Med 2017; 377:233-245; July 20, 2017

13 pp. 464 kB
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1615822

In sub-Saharan Africa, among patients with advanced human immunodeficiency virus (HIV) infection, the rate of death from infection (including tuberculosis and cryptococcus) shortly after the initiation of antiretroviral therapy (ART) is approximately 10%. In this factorial open-label trial conducted in Uganda, Zimbabwe, Malawi, and Kenya, the authors conclude that among HIV-infected patients with advanced immunosuppression, enhanced antimicrobial prophylaxis combined with ART resulted in reduced rates of death at both 24 weeks and 48 weeks without compromising viral suppression or increasing toxic effects.

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