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Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV

Authors
 Stephane Wen‐Wei Ku  ;  Awachana Jiamsakul  ;  Kedar Joshi  ;  Mark Kristoffer Ungos Pasayan  ;  Alvina Widhani  ;  Romanee Chaiwarith  ;  Sasisopin Kiertiburanakul  ;  Anchalee Avihingsanon  ;  Penh Sun Ly  ;  Nagalingeswaran Kumarasamy  ;  Cuong D Do  ;  Tuti P Merati  ;  Kinh Van Nguyen  ;  Adeeba Kamarulzaman  ;  Fujie Zhang  ;  Man Po Lee  ;  Jun Yong Choi  ;  Junko Tanuma  ;  Suwimon Khusuwan  ;  Benedict Lim Heng Sim  ;  Oon Tek Ng  ;  Winai Ratanasuwan  ;  Jeremy Ross  ;  Wing‐Wai Wong 
Citation
 JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, Vol.22(3) : e25264, 2019 
Journal Title
JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
Issue Date
2019
Keywords
AIDS ; HIV ; Asia ; cohort studies ; cotrimoxazole ; prophylaxis ; sulphamethoxazole/trimethoprim ; tuberculosis
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.
Files in This Item:
T201904285.pdf Download
DOI
10.1002/jia2.25264
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/173209
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