Affiliations 

  • 1 Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • 2 The Kirby Institute, UNSW Sydney, NSW, Australia
  • 3 Institute of Infectious Diseases, Pune, India
  • 4 Research Institute for Tropical Medicine, Manila, Philippines
  • 5 Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 6 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 7 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 8 Faculty of Medicine, Chulalongkorn University and HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 9 National Center for HIV/AIDS, Dermatology & STDs, and University of Health Sciences, Phnom Penh, Cambodia
  • 10 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
  • 11 Bach Mai Hospital, Hanoi, Vietnam
  • 12 Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
  • 13 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 14 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 15 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 16 Queen Elizabeth Hospital, Hong Kong SAR, China
  • 17 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 18 National Center for Global Health and Medicine, Tokyo, Japan
  • 19 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 20 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 21 Tan Tock Seng Hospital, Tan Tock Seng, Singapore
  • 22 Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 23 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
PMID: 30924281 DOI: 10.1002/jia2.25264

Abstract

INTRODUCTION: Cotrimoxazole (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.

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. Factors associated with new TB diagnoses after cohort entry and survival after cART initiation were analysed using Cox regression, stratified by site.

RESULTS: A 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.