***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 Pneumocystis jiroveci pneumonia ( PCP ) prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm3 . This study examines the proportion of patients in the TREAT Asia HIV Observational Data base ( TAHOD ) receiving PCP prophylaxis  , and its effect on PCP and mortality . Methods TAHOD patients with prospect i ve follow up had data extracted for prophylaxis using co-trimoxazole , dapsone or pentamidine . The proportion of patients on prophylaxis was calculated for each calendar year since 2003 among patients with CD4 counts of less than 200 cells/mm3 . The effect of prophylaxis on PCP and survival were assessed using r and om-effect Poisson regression models . Results There were a total of 4050 patients on prospect i ve follow up , and 90 % of them were receiving combination antiretroviral therapy .  Of those with CD4 counts of less than 200 cells/mm3 , 58 % to 72 % in any given year received PCP prophylaxis , predominantly co-trimoxazole . During follow up , 62 patients developed PCP ( 0.5 per 100 person-years ) and 169 died from all causes ( 1.36/100 person-years ) . After stratifying by site and adjusting for age , CD4 count , CDC stage and antiretroviral treatment , those without prophylaxis had no higher risk of PCP , but had a significantly higher risk of death ( incident rate ratio 10.8 , p < 0.001 ) . PCP prophylaxis had greatest absolute benefit in patients with CD4 counts of less than 50 cells/mm3 , lowering mortality rates from 33.5 to 6.3 per 100 person-years . Conclusions Approximately two-thirds of TAHOD patients with CD4 counts of less than 200 cells/mm3 received PCP prophylaxis . Patients without prophylaxis had significantly higher mortality , even in the era of combination ART . Although PCP may be under-diagnosed , these data suggest that prophylaxis is associated with important survival benefits Background There have been few reports of long-term survival of HIV-infected patients on antiretroviral therapy ( ART ) in Africa managed under near normal health service conditions . Methods Participants starting ART between February 2005 and December 2006 in The AIDS Support ( TASO ) clinic in Jinja , Ug and a , were enrolled into a cluster-r and omised trial of home versus facility-based care and followed up to January 2009 . The trial was integrated into normal service delivery with patients managed by TASO staff according to national guidelines . Rates of survival , virological failure , hospital admissions and CD4 count over time were similar between the two arms . Data for the present analysis were analysed using Cox regression analyses . Results 1453 subjects were enrolled with baseline median count of 108 cells/μl . Over time , 119 ( 8 % ) withdrew and 34 ( 2 % ) were lost to follow-up . 197/1453 ( 14 % ) died . Mortality rates ( 95 % CI ) per 100 person-years were 11.8 ( 10.1 , 13.8 ) deaths in the first year and 2.4 ( 1.8 , 3.2 ) deaths thereafter . The one , two and three year survival probabilities ( 95 % CI ) were 0.89 ( 0.87 - 0.91 ) , 0.86 ( 0.84 - 0.88 ) and 0.85 ( 0.83 - 0.87 ) respectively . Low baseline CD4 count , low body weight , advanced clinical condition ( WHO stages III and IV ) , not being on cotrimoxazole prophylaxis and male gender were associated independently with increased mortality . Tuberculosis , cryptococcal meningitis and diarrhoeal disease were estimated to be major causes of death . Conclusion Practical and affordable interventions are needed to enable earlier initiation of ART and to reduce mortality risk among those who present late for treatment with advanced disease Objective To assess the impact of prophylactic oral co-trimoxazole in reducing mortality in HIV positive Zambian adults being treated for pulmonary tuberculosis . Design Double blind placebo controlled r and omised clinical trial . Participants Two groups of antiretroviral treatment naive adults with HIV infection : patients newly diagnosed as having tuberculosis and receiving tuberculosis treatment either for the first time or for retreatment after relapse ; previously treated patients not receiving treatment . Intervention Oral co-trimoxazole or matching placebo daily . Primary outcome measures Time to death and occurrence of serious adverse events related to study drug . Results 1003 patients were r and omised : 835 ( 416 co-trimoxazole , 419 placebo ) were receiving treatment for tuberculosis , 762 ( 376 co-trimoxazole  , 386 placebo )  of them newly diagnosed previously untreated patients and 73 ( 40 co-trimoxazole , 33 placebo ) receiving a retreatment regimen ; 168 ( 84 co-trimoxazole , 84 placebo ) were not on treatment but had received treatment in the past . Of 835 participants receiving tuberculosis treatment , follow-up information was available for 757 , with a total of 1012.6 person years of follow-up . A total of 310 ( 147 co-trimoxazole , 163 placebo ) participants died , corresponding to death rates of 27.3 and 34.4 per 100 person years . In the Cox regression analysis , the hazard ratio for death  ( co-trimoxazole : placebo ) was 0.79 ( 95 % confidence interval 0.63 to 0.99 ) . The effect of co-trimoxazole waned with time , possibly owing to falling adherence levels ; in a per protocol analysis based on patients who spent at least 90 % of their time at risk supplied with study drug , the hazard ratio was 0.65 ( 0.45 to 0.93 ) . Conclusions Prophylaxis with co-trimoxazole reduces mortality in HIV infected adults with pulmonary tuberculosis .  Co-trimoxazole was generally safe and well tolerated . Trial registration Current Controlled Trials IS RCT N15281875 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 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 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 
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The 4 assessed CE studies showed that provision of CTX prophylaxis is cost effective and sometimes cost saving .
CONCLUSIONS CTX prophylaxis is a cost-effective intervention with expected high impact on morbidity and mortality reduction in HIV-infected adults in re source -limited setting s. Benefits are seen in both pre-antiretroviral therapy and antiretroviral therapy population