The Anti-inflammatory Effects of Cotrimoxazole Prophylaxis for People Living With Human Immunodeficiency Virus in Sub-Saharan Africa.

Abstract

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