Open AccessCotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV
Author(s) -
Ku Stephane WenWei,
Jiamsakul Awachana,
Joshi Kedar,
Pasayan Mark Kristoffer Ungos,
Widhani Alvina,
Chaiwarith Romanee,
Kiertiburanakul Sasisopin,
Avihingsa Anchalee,
Ly Penh Sun,
Kumarasamy Nagalingeswaran,
Do Cuong D,
Merati Tuti P,
Nguyen Kinh Van,
Kamarulzaman Adeeba,
Zhang Fujie,
Lee Man Po,
Choi Jun Yong,
Tanuma Junko,
Khusuwan Suwimon,
Sim Benedict Lim Heng,
Ng Oon Tek,
Ratanasuwan Winai,
Ross Jeremy,
Wong WingWai
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25264
Subject(s) - medicine , tuberculosis , cohort , hazard ratio , cart , proportional hazards model , coinfection , cohort study , incidence (geometry) , body mass index , immunology , human immunodeficiency virus (hiv) , confidence interval , pathology , mechanical engineering , physics , optics , engineering
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 ), CD 4 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 , CD 4 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.