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An antibiotic commonly used to treat respiratory infections could help prevent deaths in children infected with HIV — even in areas with high resistance to the drug — according to research published in The Lancet today (19 November).

The research team, led by Dianne Gibb, from the UK Medical Research Council's clinical trials unit, tested the preventive effect of the antibiotic co-trimoxazole in 540 Zambian children between the ages of one and 14 years.

The researchers say the antibiotic cut AIDS-related deaths in HIV-infected children by 43 per cent. It also reduced the number of children admitted to hospital with respiratory conditions by 23 per cent.

The children were divided into two groups, with one given the antibiotic and the other receiving a placebo. Results after 19 months were so positive that a committee monitoring the study recommended the trial should be stopped, so the children in the placebo group could have antibiotic treatment too.

The cheap and widely available drug is used to treat respiratory infections such as pneumonia, which can be dangerous for HIV-infected people given the vulnerability of their immune systems. The antibiotic has proved effective in preventing deaths from respiratory disease in HIV-infected people who live in areas with low bacterial resistance to the drug.

But scientists have been concerned that the drug would not work as well in countries such as Zambia, where antibiotic resistance is high. This trial shows the first promising evidence to the contrary, say the researchers.

The team's findings highlight the fact that research into tackling AIDS-related illnesses is just as important as studies on antiretrovirals and AIDS vaccines. "Tackling HIV infection directly is just one approach," says Gibb. "Reducing the secondary complications and infections, which can be just as fatal as HIV itself to those with weak immune systems, is also important."

According to the World Health Organisation, at the end of 2003, 2.1 million children under 15 were infected with HIV, of whom 1.9 million were African.

Link to full research paper in The Lancet*

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