BioEd Online

An antibiotic that costs only pennies per day could drastically reduce deaths from HIV in African children, according to a clinical trial. The World Health Organization (WHO) is recommending widespread use of the drug.

The human immunodeficiency virus, HIV, kills around 1,300 children daily. Many of them die from routine childhood infections, which overwhelm an immune system that has been hobbled by the virus.

A team led by Diana Gibb at the Medical Research Council Clinical Trials Unit, London, tested whether a widely available antibiotic called co-trimoxazole could prevent some of these deaths. They gave the drug or a placebo to 541 children, aged between 1 and 14, in Zambia.

The drug cut the death rate among those who took the drug by 43%, the team found. The preliminary findings prompted the researchers to stop the trial early, in October last year, and the complete results are published today in the Lancet¹.

"It's certainly a very important and exciting finding," says Siobhan Crowley, an HIV medical officer at the WHO in Geneva, Switzerland. The drug probably fights off a range of common bacteria that can spell death for children.

Universal prescription

Co-trimoxazole is already a first line of defence against HIV-related infections. But the WHO currently recommends that only certain children should receive it, such as weeks-old babies whose mothers carry the virus and older children whose levels of white blood cells are flagging.

Now the WHO is revising these guidelines to recommend that the drug should be prescribed universally for African children showing any symptom of HIV infection. "We'd like to ensure there is an uninterrupted drug supply," Crowley says.

Widespread use of the antibiotic raises concerns that bacteria might acquire resistance to the drug. But the new trial was carried out in a region where antibiotic resistance to co-trimoxazole is already common, and the drug still worked, suggesting that enough susceptible bacteria remain for the drug to have an effect. Previously, medical workers have been dubious that it would work in such regions, so this result may help make a case for wider use of the antibiotic in adults too.

The antibiotic should not, however, be seen as a substitute for antiretroviral therapy in children, Crowley warns, which can cut the death rate by as much as 80%. "It's not an either/or," she says. But these medicines cost at least a few hundred dollars a year per person and are not yet widely used in African children.