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Exercise

Scenario


According the WHO recommendations 2006 (see table below), in settings in which co-trimoxazole prophylaxis is initiated based on WHO clinical staging criteria only, co-trimoxazole prophylaxis is recommended for all symptomatic people with mild, advanced or severe HIV disease (WHO clinical stages 2, 3 or 4). Where CD4 cell testing is available, co-trimoxazole prophylaxis is recommended for everyone with a CD4 cell count <350 per mm3. People with WHO clinical stage 3 or 4 HIV disease (including people with pulmonary as well as extrapulmonary TB) should, however, still initiate co-trimoxazole prophylaxis irrespective of the CD4 cell count.

However some countries may also opt to treat everyone living with HIV (universal option), because of operational simplicity and data suggesting a reduction of severe events irrespective of CD4 count or clinical stage [C-III]. This strategy may be considered in settings with high prevalence of HIV and limited health infrastructure.

Activity

These recommendations are based on evidence available in 2006.
  1. Search the literature beyond 2006 (from 2007 till 2011) for arguments (new evidence) in favour or against these recommendations.
  2. Depending on your finding, does the level of evidence change?
  3. Based on the new evidence found, try to reformulate the recommendations.