***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: 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 Objectives : Among HIV-1-infected individuals in Africa , coinfection with malaria and diarrhoeal disease may be associated with more rapid HIV-1 disease progression . We sought to determine whether the use of long-lasting insecticide-treated bed nets and simple point-of-use water filters can delay HIV-1 disease progression . Design : A prospect i ve cohort study . Setting : Two HIV care sites in Kenya . Participants : HIV-1-infected adults not yet meeting criteria for antiretroviral therapy . Interventions : One group received the st and ard of care , whereas the other received long-lasting insecticide-treated bed nets and water filters . Individuals were followed for up to 24 months . Main outcome measures : The primary outcome measures were time to CD4 cell count less than 350 cells/&mgr;l and a composite endpoint of time to CD4 cell count less than 350 cells/&mgr;l and nontraumatic death . Time to disease progression was compared using Cox proportional hazards regression . Results : Of 589 individuals included , 361 received the intervention and 228 served as controls .  Median baseline CD4 cell counts were similar ( P = 0.36 ) . After controlling for baseline CD4 cell count , individuals receiving the intervention were 27 % less likely to reach the endpoint of a CD4 cell count less than 350 cells/&mgr;l ( hazard ratio 0.73 ; 95 % confidence interval 0.57–0.95 ) . CD4 cell count decline was also significantly less in the intervention group ( −54 vs. −70 cells/&mgr;l per year , P = 0.03 ) . In addition , the incidence of malaria and diarrhoea were significantly lower in the intervention group . Conclusion : Provision of a long-lasting insecticide-treated bed net and water filter was associated with a delay in CD4 cell count decline and may be a simple , practical and cost-effective strategy to delay HIV-1 progression in many re source -limited setting OBJECTIVE To estimate the effectiveness , costs and cost-effectiveness of providing long-lasting insecticide-treated nets ( LLINs ) and point-of-use water filters to  antiretroviral therapy (ART)-naïve HIV-infected adults and their family members , in the context of a multisite study in Kenya of 589 HIV-positive adults followed on average for 1.7 years . METHODS The effectiveness , costs and cost-effectiveness of the intervention were estimated using an epidemiologic-cost model . Model epidemiologic inputs were derived from the Kenya multisite study data , local epidemiological data and from the published literature . Model cost inputs were derived from published literature specific to Kenya . Uncertainty in the model estimates was assessed through univariate and multivariate sensitivity analyses . RESULTS We estimated net cost savings of about US$ 26 000 for the intervention , over 1.7 years . Even when ignoring net cost savings , the intervention was found to be very cost-effective at a cost of US$ 3100 per death averted or US$ 99 per disability-adjusted life year ( DALY ) averted . The findings were robust to the sensitivity analysis and remained most sensitive to both the duration of ART use and the cost of ART per person-year . CONCLUSIONS The provision of LLINs and water filters to ART-naïve HIV-infected adults in the Kenyan study result ed in substantial net cost savings , due to the delay in the initiation of ART . The addition of an LLIN and a point-of-use water filter to the existing package of care provided to ART-naïve HIV-infected adults could bring substantial cost savings to re source -constrained health systems in low- and middle-income countries During a r and omized placebo-controlled trial of chemoprophylaxis against  Plasmodium falciparum malaria  and iron supplementation , in infants living under conditions of intense transmission , all sample s of P. falciparum obtained from children aged 5 and 8 months were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis for the msp2 locus . One hundred and six blood sample s were analysed for the number of concurrent infections ( multiplicity ) , and the allelic family of each msp2 genotype was determined . Mean multiplicity of infection was , overall , 2.76 infections/child , and it was significantly reduced in infants receiving chemoprophylaxis . This finding might help to explain the rebound effect in morbidity observed after prophylaxis was ended . Iron supplementation did not affect multiplicity of infection . In infants receiving placebo only , or placebo and  iron supplementation  , a significant positive association was observed between the number of infections and parasite densities ( Spearman 's p = 0.25 , P-0.047 ) . This association was lost in the group receiving chemoprophylaxis  alone , or in combination with iron . This study showed a significant association of FC27-like msp2 alleles with prospect i ve risk of clinical malaria in children ( relative risk = 1.487 , P = 0.013 ) . Such an association was also found for the present risk of clinical malaria in infants receiving prophylaxis ( odds ratio = 3.84 , P = 0.026 ) , which might imply that chemoprophylaxis may impair the development of premunition BACKGROUND Human immunodeficiency virus ( HIV ) and malaria during pregnancy cause substantial perinatal mortality . As co-trimoxazole ( CMX ) protects children and HIV-positive adults against malaria , we compared the effectiveness of daily CMX with sulfadoxine-pyrimethamine intermittent preventive treatment ( IPT-SP ) on malaria risk in HIV-positive pregnant women in a Plasmodium falciparum-endemic African area . METHODS From January 2009 to April 2011 , we included in a r and omized noninferiority trial all HIV type 1-infected pregnant women ( ≤28 weeks ' gestation , CD4 count ≥200 cells/µL , hemoglobin level ≥7 g/L ) in 19 health centers in Togo . Women were r and omly assigned to daily 800 mg/160 mg CMX , or IPT-SP . The primary outcome was the proportion of malaria-free pregnancies . Other outcomes included malaria incidence , parasitemia , placental malaria , anemia , and infants ' birth weight . RESULTS Of 264 women r and omly assigned to the CMX or IPT-SP group , 126 of 132 and 124 of 132 , respectively , were included in the analysis . There were 33 confirmed cases of clinical malaria among 31 women in the CMX group , and 19 among 19 women in the IPT-SP group . Ninety-five of 126 ( 75.4 % ) women in the CMX group and 105 of 124 ( 84.7 % ) in the IPT-SP group remained malaria-free during their pregnancy ( difference , 9.3 % ; 95 % confidence interval [ CI ] , -.53 to 19.1 , not meeting the predefined noninferiority criterion ) . The incidence rate in intention-to-treat analysis was 108.8 malaria episodes per 100 person-years in CMX ( 95 % CI , 105.4 - 112.2 ) and 90.1 in IPT-SP ( 95 % CI , 86.8 - 93.4 ) ( not significant ) . Prevalence of parasitemia was 16.7 % in the CMX group vs 28 % in the IPT-SP group ( P = .02 ) . Histology revealed 20.3 % placental malaria in the CMX group vs. 24.6 % in the IPT-SP group ( not significant ) . Grade 3 - 4 anemia was more frequent in the CMX group ( 10 % vs 4 % ; P = .008 ) . No pregnant women died . Median birth weight was similar . CONCLUSIONS Daily CMX was not noninferior to IPT-SP for preventing maternal malaria but safe and at least similar regarding parasitemia or placental malaria and birth outcomes . Clinical Trials Registration IS RCT N98835811 Summary Background Co-trimoxazole prophylaxis can reduce mortality from untreated HIV infection in Africa ; whether benefits occur alongside combination antiretroviral therapy ( ART ) is unclear . We estimated the effect of prophylaxis after ART initiation in adults . Methods Participants in our observational analysis were from the DART r and omised trial of management strategies in HIV-infected , symptomatic , previously untreated African adults starting triple-drug ART with CD4 counts lower than 200 cells per μL.  Co-trimoxazole prophylaxis was not routinely used or r and omly allocated , but was variably prescribed by clinicians . We estimated effects on clinical outcomes , CD4 cell count , and body-mass index ( BMI ) using marginal structural models to adjust for time-dependent confounding by indication . DART was registered , number IS RCT N13968779 . Findings 3179 participants contributed 14 214 years of follow-up ( 8128 [ 57 % ] person-years on co-trimoxazole ) . Time-dependent predictors of co-trimoxazole use were current CD4 cell count , haemoglobin concentration , BMI , and previous WHO stage 3 or 4 events on ART . Present prophylaxis significantly reduced mortality ( odds ratio 0·65 , 95 % CI 0·50–0·85 ; p=0·001 ) . Mortality risk reduction on ART was substantial to 12 weeks ( 0·41 , 0·27–0·65 ) , sustained from 12–72 weeks ( 0·56 , 0·37–0·86 ) , but not evident subsequently ( 0·96 , 0·63–1·45 ; heterogeneity p=0·02 ) . Variation in mortality reduction was not accounted for by time on co-trimoxazole or current CD4 cell count . Prophylaxis reduced frequency of malaria ( 0·74 , 0·63–0·88 ; p=0·0005 ) , an effect that was maintained with time , but we observed no effect on new WHO stage 4 events ( 0·86 , 0·69–1·07 ; p=0·17 ) , CD4 cell count ( difference vs non-users , −3 cells per μL [ −12 to 6 ] ; p=0·50 ) , or BMI ( difference vs non-users , −0·04 kg/m2 [ −0·20 to 0·13 ) ; p=0·68 ] . Interpretation Our results reinforce WHO guidelines and provide strong motivation for provision of co-trimoxazole prophylaxis for at least 72 weeks for all adults starting combination ART in Africa . Funding UK Medical Research Council , the UK Department for International Development , the Rockefeller Foundation , GlaxoSmithKline , Gilead Sciences , Boehringer-Ingelheim , and Abbott Laboratories BACKGROUND Cotrimoxazole prophylaxis prolongs surv 
    Output:
    
CTX prophylaxis is effective in reducing malaria-related morbidity among PLHIV .
Limited evidence is available with respect to the impact and the CE of ITN use and /or provision in this population