Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV.

Stephane Wen‐Wei Ku ,Alvina Widhani,Junko Tanuma,Anchalee Avihingsanon,Adeeba Kamarulzaman,Kinh Van Nguyen,Fujie Zhang,Jeremy Ross,Winai Ratanasuwan,Awachana Jiamsakul,Romanee Chaiwarith,Suwimon Khusuwan,Sasisopin Kiertiburanakul,Mark Kristoffer Ungos Pasayan,Kedar Joshi,Nagalingeswaran Kumarasamy,Penh Sun Ly,Man Po Lee,Benedict Lim Heng Sim,Jun Yong Choi,Oon Tek Ng,Tuti Parwati Merati ,Dd Cuong ,Wing‐Wai Wong

doi:10.1002/jia2.25264

Abstract

IntroductionCotrimoxazole (CTX) is recommended as prophylaxis against Pneumocystis jiroveci pneumonia, malaria and other serious bacterial infections in HIV‐infected patients. Despite its in vitro activity against Mycobacterium tuberculosis, the effects of CTX preventive therapy on tuberculosis (TB) remain unclear.MethodsAdults living with HIV enrolled in a regional observational cohort in Asia who had initiated combination antiretroviral therapy (cART) were included in the analysis. Factors associated with new TB diagnoses after cohort entry and survival after cART initiation were analysed using Cox regression, stratified by site.ResultsA total of 7355 patients from 12 countries enrolled into the cohort between 2003 and 2016 were included in the study. There were 368 reported cases of TB after cohort entry with an incidence rate of 0.99 per 100 person‐years (/100 pys). Multivariate analyses adjusted for viral load (VL), CD4 count, body mass index (BMI) and cART duration showed that CTX reduced the hazard for new TB infection by 28% (HR 0.72, 95% CI l 0.56, 0.93). Mortality after cART initiation was 0.85/100 pys, with a median follow‐up time of 4.63 years. Predictors of survival included age, female sex, hepatitis C co‐infection, TB diagnosis, HIV VL, CD4 count and BMI.Conclusions CTX was associated with a reduction in the hazard for new TB infection but did not impact survival in our Asian cohort. The potential preventive effect of CTX against TB during periods of severe immunosuppression should be further explored.

Highlights

Cotrimoxazole (CTX) is recommended as prophylaxis against Pneumocystis jiroveci pneumonia, malaria and other serious bacterial infections in HIV-infected patients
This study aims to examine the incidence of TB and survival in HIV-infected patients receiving and not receiving CTX prophylaxis in a regional observational cohort in Asia
A total of 7328 patients were included in Analysis (ii) as they had at least one day of followup from the latter of cohort enrolment date or date of combination antiretroviral therapy (cART) initiation (Figure 1)

Summary

Introduction

Cotrimoxazole (CTX) is recommended as prophylaxis against Pneumocystis jiroveci pneumonia, malaria and other serious bacterial infections in HIV-infected patients. Methods: Adults living with HIV enrolled in a regional observational cohort in Asia who had initiated combination antiretroviral therapy (cART) were included in the analysis. Cotrimoxazole (CTX) has been recommended as prophylaxis against Pneumocystis jiroveci pneumonia (PJP), toxoplasmosis, malaria and other serious bacterial infections in adults with severe or advanced HIV clinical disease, with a CD4 count less than 350 cells/lL or less than 200 cells/lL (depending on region), by the World Health Organization (WHO) [1,2]. The first randomized controlled trial conducted in Co^te d’Ivoire has demonstrated that daily CTX prophylaxis was well tolerated and significantly decreased mortality and hospital admission rates in HIV-infected patients with

Objectives

Results

Conclusion