The Anti-inflammatory Effects of Cotrimoxazole Prophylaxis for People Living With Human Immunodeficiency Virus in Sub-Saharan Africa.
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Publisher
DOI
10.1093/infdis/jiz495
Journal
J Infect Dis
ISSN
0022-1899
Metadata
Show full item recordAbstract
Cotrimoxazole prophylaxis reduces morbidity and mortality among people living
with human immunodeficiency virus
(HIV) in sub-Saharan Africa, regardless
of age, degree of immunosuppression,
disease stage, or duration of antiretroviral therapy (ART) [1–6]. Long-term
cotrimoxazole is therefore included in
World Health Organization (WHO) recommendations for people with HIV
in areas with a high prevalence of severe bacterial infections and/or malaria
[7]. It is surprising that cotrimoxazole
confers such clinical benefits, given the
high prevalence of antimicrobial resistance among its key target pathogens in
sub-Saharan Africa [8]. The conundrum
of how cotrimoxazole works has led to
recent interest in assessing its impact on
immune activation, which is a cardinal
feature of HIV infection. Soluble and cellular markers of immune activation have
been associated with morbidity and mortality independent of CD4 cell count in
numerous studies across diverse settings