Sub Saharan Africa

Most hospitals in sub-Saharan Africa do not currently have facilities for CD4+-lymphocyte counts. Infection with MAC is rare. UNAIDS has made provisional recommendations that adults and children living with HIV/AIDS in Africa should receive TMP-SMX as part of a minimum package of care. UNAIDS has based these recommendations on evidence from industrialized countries and studies carried out in Côte d'Ivoire on both HIV-positive TB patients and symptomatic HIV-positive patients without TB.TMP-SMX may prevent several secondary bacterial (S. pneumoniae, S. typhimurium), parasitic (Toxoplasma gondii, Isospora belli, malaria) and fungal (Pneumocystis carinii) infections.

The following HIV-positive adults should receive TMP-SMX in a dose of two tablets daily:

° all persons with symptomatic HIV infection; ° asymptomatic persons with CD4+ lymphocyte count < 500/mm3; ° pregnant women after the first trimester.

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