A clinical trial involving HIV-positive children in sub-Saharan Africa has revealed that a common antibiotic significantly improves health – despite widespread antibiotic resistance.
In a paper published in the journal Science Translational Medicine, researchers led by Claire Bourke from the Queen Mary University of London in the UK detail a trial involving 293 children in Zimbabwe and Uganda.
The children were all given the antibiotic cotrimoxazole for a minimum of 96 weeks.
The antibiotic has long been recognised for its prophylactic effect in people with HIV and AIDS, and is recommended by the World Health Organisation as “an affordable, safe and feasible intervention for resource-limited countries” dealing with HIV cases.
In the latest investigation to drill down into the effects of the medication, Bourke and colleagues studied plasma samples taken from the Ugandan and Zimbabwean cohort. After 96 weeks, treatment was halted for half of the children, and continued for the remainder.
The researchers found that those who continued treatment had lower rates of systemic inflammation and lower streptococcal bacterial activity than those who stopped. The latter group, also recorded an 18% higher risk of adverse health events, such as pneumonia, within 48 weeks of ceasing the antibiotics.
Cotrimoxazole was found to exert direct effects on the children’s immune cells. A small secondary trial found that the antibiotic also reduced inflammatory molecule production in HIV-positive adults.
Significantly, the antibiotic worked despite high levels of resistance found among the target population.
“Collectively we demonstrate that cotrimoxazole reduces systemic and intestinal inflammation both indirectly via antibiotic effects on the microbiome and directly by blunting immune and epithelial cell activation,” Bourke and colleagues conclude.
“Synergy between these pathways may explain the clinical benefits of cotrimoxazole despite high antimicrobial resistance, providing further rationale for extending coverage among people living with HIV in sub-Saharan Africa.”