Table 3 Policy Guidelines for Cotrimoxazole Preventive Therapy in Malawi (2005)

In Adults:

Cotrimoxazole should be offered to the following HIV-positive adults (aged 15 years and above):

   • All persons with symptomatic HIV disease (WHO Clinical Stage 2,3 and 4)

   • All persons who have a CD4-lymphocyte count of 500/mm³ or less, regardless of symptoms

   • Pregnant women after the first trimester who are symptomatic or have a CD4-lymphocyte count < 500/mm³

Note: In adults there is not enough evidence to recommend cotrimoxazole to HIV-positive adults who are asymptomatic (i.e., WHO Clinical Stage 1). However, if evidence is forthcoming in the future to support a change, then this recommendation will be re-examined. It is also felt that the threshold of CD4-count of 500 cells/mm ³ may be too high, but it is agreed to stay with this threshold as it is similar to that recommended by the World Health Organization. Again, if evidence is forthcoming in the future that this threshold is too high, the recommendation will be re-examined

In Children:

Cotrimoxazole should be offered to children in the following circumstances:

   • Any child, aged 6 weeks or above, born to an HIV-positive woman irrespective of whether the woman received antiretroviral therapy in pregnancy

   • Any child, 6 weeks or more, who is HIV-positive regardless of symptoms

Note: All HIV-positive children should be offered cotrimoxazole because they have higher viral loads than adults, progress faster to AIDS and to death compared with adults and at present do not have the same opportunities to access antiretroviral therapy as adults