***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Presumptive treatment of malaria is common practice in malaria endemic re source -limited setting s. With the changing epidemiology of malaria and the introduction of artemisinin-based combination therapy ( ACT ) , there is increasing need for parasite-based malaria case management to prevent unnecessary use of anti-malarial medicines , improve patient care in parasite-positive patients and identify parasite-negative patients in whom another diagnosis must be sought . Although parasitological confirmation by microscopy or alternatively by malaria rapid diagnostic tests ( RDTs ) is recommended in all patients suspected of malaria before treatment , gaps remain in the implementation of this policy in re source -limited setting s. There is need to evaluate the use of RDTs among highly active anti-retroviral therapy (HAART)-treated people living with HIV ( PLHIV ) . Methods Within an urban prospect i ve observational research cohort of 559 PLHIV initiated on HAART and cotrimoxazole prophylaxis between April , 2004 and April , 2005 , 128 patients with sustained HIV-RNA viral load < 400 copies/ml for four years were evaluated , in a cross-sectional study , for asymptomatic malaria infection using a histidine-rich protein-2 ( HRP-2 ) RDT to detect Plasmodium falciparum antigen in peripheral blood . Patients with positive RDT results had microscopy performed to determine the parasite densities and were followed for clinical signs and symptoms during the subsequent six months . Results Of the 128 asymptomatic patients screened , only 5 ( 4 % ) had asymptomatic P. falciparum antigenaemia . All the patients with positive HRP2 RDT results showed malaria parasites on thick film with parasite densities ranging from 02 - 15 malaria parasites per high power field . None of the patients with positive RDT results reported signs and symptoms of malaria infection during the subsequent six months . Conclusions In an urban area of low to moderate stable malaria transmission , there was low HRP2 P. falciparum antigenaemia among PLHIV after long-term HAART and cotrimoxazole prophylaxis . Parasite-based malaria diagnosis ( PMD ) is recommended among PLHIV that are on long-term anti-retroviral therapy . RDTs should be utilized to exp and PMD in similar setting s where microscopy is unavailable The purpose of this prospect i ve cohort study was to assess the effect of cotrimoxazole prophylaxis taken by human immunodeficiency virus (HIV)-infected persons on the selection of sulfadoxine-pyrimethamine (SP)-resistant malaria parasites among HIV-uninfected household members . A total of 2,567 HIV-uninfected persons from 605 households were followed and blood specimens were collected each time an episode of Plasmodium falciparum malaria was diagnosed . Study participants were living in households where HIV-infected persons were either taking ( exposed ) or not taking ( unexposed ) cotrimoxazole prophylaxis .  From all malaria episodes diagnosed , 50 % of the specimens were r and omly selected and tested for the presence of five key mutations known to mediate resistance to SP ( dihydrofolate reductase [ dhfr ] Asn-108 , Ile-51 , and Arg-59 , and dihydropteroate synthase [ dhps ] Gly-437 and Glu-540 ) . Plasmodium falciparum isolates were recovered from 163 specimens in the exposed households and 113 specimens in the unexposed households , with similar proportions containing the dhfr triple mutant ( 37 % versus 45 % ; P = 0.18 ) , the dhps double mutant ( 64 % versus 62 % ; P = 0.81 ) , and the dhfr/dhps quintuple mutant ( 30 % versus 32 % ; P = 0.74 ) . The HIV-uninfected persons living with HIV-infected household members taking cotrimoxazole prophylaxis had a lower incidence of malaria ( incidence rate ratio [ IRR ] = 0.64 , 95 % confidence interval [ CI ] = 0.50 - 0.83 , P = 0.001 ) and fewer malaria episodes due to parasites containing the dhfr/dhps quintuple mutant ( IRR = 0.61 , 95 % CI = 0.41 - 0.91 , P = 0.014 ) . Cotrimoxazole prophylaxis taken by HIV-infected persons did not select for SP-resistant malaria parasites among HIV-uninfected household members , and was associated with a lower overall incidence of SP-resistant malaria among household members Background : The effect of cotrimoxazole prophylaxis taken by persons with HIV on community health and antimicrobial resistance is unknown . Objective : To assess the effect of cotrimoxazole prophylaxis taken by persons with HIV on morbidity , mortality , and antimicrobial resistance of diarrheal pathogens infecting their HIV-negative family members . Design : Prospect i ve cohort in rural Ug and a. Methods : A total of 879 persons with HIV and 2771 HIV-negative family members received weekly home-visits . After 5 months , persons with HIV received daily cotrimoxazole prophylaxis and households were followed for an average of 17 additional months . Findings : During the study , 224 participants with HIV ( 25 % ) and 29 household members ( 1 % ) died . Mortality among  HIV-negative family members < 10 years old was 63 % less during the cotrimoxazole period than before [ hazard ratio , 0.37 ; 95 % confidence interval ( CI ) , 0.14–0.95 ; P = 0.04 ] . Malaria among family members was less common during cotrimoxazole treatment [ incidence rate ratio ( IRR ) , 0.62 ; CI , 0.53–0.74 ; P < 0.0001 ] , as were diarrhea ( IRR , 0.59 ; CI , 0.45–0.76 ; P = 0.0001 ) , and hospitalizations ( IRR , 0.57 ; CI , 0.36–0.92 ; P = 0.02 ) . Death of a parent with HIV was associated with a threefold increase in mortality among HIV-negative children < 10 years old ( hazard ratio , 2.9 ; CI , 1.1–8.1 ; P = 0.04 ) . Of 134 bacterial isolates from family members before cotrimoxazole treatment , 89 ( 66 % ) were resistant to cotrimoxazole ; of 75 recovered during cotrimoxazole treatment , 54 ( 72 % ) were resistant ( P = 0.41 ) . Interpretation : Cotrimoxazole prophylaxis taken by persons with HIV was associated with decreased morbidity and mortality among family members . Antimicrobial resistance among diarrheal pathogens infecting family members did not increase . Concerns regarding the spread of bacterial resistance should not impede implementation of cotrimoxazole programs Objective To evaluate the proposed WHO/UNAIDS criteria for initiating co-trimoxazole prophylaxis in adult HIV-infected patients in Africa [ WHO clinical stages 2–4 or CD4 count < 500 × 106 /l or total lymphocyte count ( TLC ) equivalent ] . Design Observational cohort study of 5-year follow-up . Setting Adult HIV clinics , University of Cape Town , South Africa . Methods Effect of prophylactic low dose co-trimoxazole ( 480 mg per day or 960 mg three times per week ) on survival and morbidity was assessed in patients stratified by WHO clinical stage , CD4 T-lymphocyte count or TLC . Patients receiving antiretroviral therapy were excluded .  Results Co-trimoxazole  reduced mortality [ adjusted hazard ratio ( AHR ) , 0.56 ; 95 % confidence interval ( CI ) , 0.33–0.85;P > 0.001 ] and the incidence of severe HIV-related illnesses ( AHR , 0.52 ; 95 % CI , 0.38–0.68;P < 0.001 ) in patients with evidence of advanced immune suppression on clinical ( WHO stages 3 and 4 ) or laboratory assessment ( TLC < 1250 × 106/l or CD4 count < 200 × 106/l ) . No significant evidence of efficacy was found in patients with WHO stage 2 or CD4 count 200–500 × 106/l/TLC 1250–2000 × 106/l . If we had applied the WHO/UNAIDS recommendations 88.3 % of our patients would have received co-trimoxazole prophylaxis at their initial clinic visit . Conclusion Co-trimoxazole in HIV-infected adults from an area in which Pneumocystis carinii pneumonia is uncommon demonstrated a survival benefit consistent with previous r and omized trials . Further studies are needed to assess the optimal time of commencement of prophylaxis , as widespread co-trimoxazole use will lead to increasing antimicrobial resistance to other major pathogens in Africa Treatment of malaria with sulfadoxine/pyrimethamine and of presumed bacterial infections with  trimethoprim/sulfamethoxazole ( cotrimoxazole ) was assessed to see if either increases the carriage of cotrimoxazole-resistant Streptococcus pneumoniae in Malawian children . Children < 5 years old treated with sulfadoxine/pyrimethamine , cotrimoxazole , or no antimicrobial agent were enrolled in a prospect i ve observational study . Nasopharyngeal swabs were taken before treatment and 1 and 4 weeks later . Pneumococci were tested for antibiotic susceptibility by broth microdilution . In sulfadoxine/pyrimethamine-treated children , the proportion colonized with cotrimoxazole-nonsusceptible pneumococci increased from 38.1 % at the initial visit to 44.1 % at the 4-week follow-up visit ( P=.048 ) . For  cotrimoxazole-treated children , the proportion colonized with cotrimoxazole-nonsusceptible pneumococci increased from 41.5 % at the initial visit to 52 % at the 1-week follow-up visit ( P=.0017 ) and returned to 41.7 % at the 4-week follow-up . Exp and ing use of sulfadoxine/pyrimethamine to treat chloroquine-resistant malaria may have implication s for national pneumonia programs in developing countries where cotrimoxazole is widely used BACKGROUND Patients with human immunodeficiency virus ( HIV ) infection are at increased risk for bacterial pneumonia in addition to opportunistic infection . However , the risk factors for bacterial pneumonia and its incidence in this population are not well defined . METHODS In a multicenter , prospect i ve , observational study , we monitored 1130 HIV-positive and 167 HIV-negative participating adults for up to 64 months for pulmonary disease . The HIV-positive group comprised 814 homosexual or bisexual men , 261 injection-drug users , and 55 female partners of HIV-infected men . RESULTS There were 237 episodes of bacterial pneumonia among the HIV-positive participants ( rate , 5.5 per 100 person-years ) , as compared with 6 episodes among the HIV-negative participants ( rate , 0.9 per 100 person-years ; P < 0.001 ) . The rate of bacterial pneumonia increased with decreasing CD4 lymphocyte counts ( 2.3 , 6.8 , and 10.8 episodes per 100 person-years in the strata with more than 500 , 200 to 500 , and fewer than 200 cells per cubic millimeter , respectively ; P < or = 0.022 for each comparison ) . Injection-drug users had a higher rate of bacterial pneumonia than did homosexual or bisexual men or female partners . In the stratum with the fewest CD4 lymphocytes , cigarette smoking was associated with an increased rate of pneumonia . Mortality was almost four times higher among participants with an episode of pneumonia than among the others . Prophylaxis with trimethoprim-sulfamethoxazole was associated with a 67 percent reduction in confirmed episodes of bacterial pneumonia ( P = 0.007 ) . CONCLUSIONS Bacterial pneumonia is more frequent in HIV-positive persons than in seronegative controls , and the risk is highest among those with CD4 lymphocyte counts below 200 per cubic millimeter and among injection-drug users Objective To evaluate the protective efficacy of co-trimoxazole prophylaxis against malaria in HIV exposed children ( uninfected children born to HIV infected mothers ) in Africa . Design Non-blinded r and omised control trial Setting Tororo district , rural Ug and a , an area of high malaria transmission intensity Participants 203 breastfeeding HIV exposed infants enrolled between 6 weeks and 9 months of age Intervention Co-trimoxazole prophylaxis from enrolment until cessation of breast feeding and confirmation of negative HIV status . All children who remained HIV uninfected ( n=185 ) were then r and omised to stop co-trimoxazole prophy 
    Output:
    
RESULT CTX is safe and efficacious against malaria .
CONCLUSION CTX is safe and still efficacious for the treatment of P.falciparum malaria in non-pregnant adults and children irrespective of HIV status and antifolate resistance profiles .
CTX prophylaxis in HIV infected individuals protects against malaria and CTX may have a role for malaria prophylaxis in specific HIV negative target groups