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Observational Study
. 2019 Mar;22(3):e25264.
doi: 10.1002/jia2.25264.

Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV

Stephane Wen-Wei Ku  1   2 , Awachana Jiamsakul  3 , Kedar Joshi  4 , Mark Kristoffer Ungos Pasayan  5 , Alvina Widhani  6 , Romanee Chaiwarith  7 , Sasisopin Kiertiburanakul  8 , Anchalee Avihingsanon  9 , Penh Sun Ly  10 , Nagalingeswaran Kumarasamy  11 , Cuong D Do  12 , Tuti P Merati  13 , Kinh Van Nguyen  14 , Adeeba Kamarulzaman  15 , Fujie Zhang  16 , Man Po Lee  17 , Jun Yong Choi  18   19 , Junko Tanuma  20 , Suwimon Khusuwan  21 , Benedict Lim Heng Sim  22 , Oon Tek Ng  23 , Winai Ratanasuwan  24 , Jeremy Ross  25 , Wing-Wai Wong  1 ; TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific
Collaborators, Affiliations
Observational Study

Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV

Stephane Wen-Wei Ku et al. J Int AIDS Soc. 2019 Mar.

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.

Keywords: AIDS; HIV; Asia; cohort studies; cotrimoxazole; prophylaxis; sulphamethoxazole/trimethoprim; tuberculosis.

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Conflict of interest statement

The authors have none to declare.

Figures

Figure 1
Figure 1
Flow diagram
Figure 2
Figure 2
TB incidence
Figure 3
Figure 3
Mortality rates
See this image and copyright information in PMC

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