Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV

TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article numbere25264
JournalJournal of the International AIDS Society
Volume22
Issue number3
DOIs
Publication statusPublished - 2019 Mar 1

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Sulfamethoxazole Drug Combination Trimethoprim
Tuberculosis
HIV
CD4 Lymphocyte Count
Viral Load
Survival
Body Mass Index
Therapeutics
Pneumocystis carinii
Pneumocystis Pneumonia
Hepatitis C
Infection
Coinfection
Mycobacterium tuberculosis
Bacterial Infections
Immunosuppression
Malaria
Multivariate Analysis
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific. / Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV. In: Journal of the International AIDS Society. 2019 ; Vol. 22, No. 3.
@article{578b3020e742472ea174c5ec6c60ac7c,
title = "Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV",
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.",
author = "{TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific} and Ku, {Stephane Wen Wei} and Awachana Jiamsakul and Kedar Joshi and Pasayan, {Mark Kristoffer Ungos} and Alvina Widhani and Romanee Chaiwarith and Sasisopin Kiertiburanakul and Anchalee Avihingsanon and Ly, {Penh Sun} and Nagalingeswaran Kumarasamy and Do, {Cuong D.} and Merati, {Tuti P.} and Nguyen, {Kinh Van} and Adeeba Kamarulzaman and Fujie Zhang and Lee, {Man Po} and JunYong Choi and Junko Tanuma and Suwimon Khusuwan and Sim, {Benedict Lim Heng} and Ng, {Oon Tek} and Winai Ratanasuwan and Jeremy Ross and Wong, {Wing Wai} and Ly, {P. S.} and V. Khol and Zhang, {F. J.} and Zhao, {H. X.} and N. Han and Lee, {M. P.} and Li, {P. C.K.} and W. Lam and Chan, {Y. T.} and N. Kumarasamy and S. Saghayam and C. Ezhilarasi and S. Pujari and K. Joshi and S. Gaikwad and A. Chitalikar and S. Sangle and V. Mave and I. Marbaniang and Wirawan, {D. N.} and F. Yuliana and E. Yunihastuti and D. Imran and A. Widhani and J. Tanuma and S. Oka",
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month = "3",
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Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV. / TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific.

In: Journal of the International AIDS Society, Vol. 22, No. 3, e25264, 01.03.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV

AU - TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific

AU - Ku, Stephane Wen Wei

AU - Jiamsakul, Awachana

AU - Joshi, Kedar

AU - Pasayan, Mark Kristoffer Ungos

AU - Widhani, Alvina

AU - Chaiwarith, Romanee

AU - Kiertiburanakul, Sasisopin

AU - Avihingsanon, Anchalee

AU - Ly, Penh Sun

AU - Kumarasamy, Nagalingeswaran

AU - Do, Cuong D.

AU - Merati, Tuti P.

AU - Nguyen, Kinh Van

AU - Kamarulzaman, Adeeba

AU - Zhang, Fujie

AU - Lee, Man Po

AU - Choi, JunYong

AU - Tanuma, Junko

AU - Khusuwan, Suwimon

AU - Sim, Benedict Lim Heng

AU - Ng, Oon Tek

AU - Ratanasuwan, Winai

AU - Ross, Jeremy

AU - Wong, Wing Wai

AU - Ly, P. S.

AU - Khol, V.

AU - Zhang, F. J.

AU - Zhao, H. X.

AU - Han, N.

AU - Lee, M. P.

AU - Li, P. C.K.

AU - Lam, W.

AU - Chan, Y. T.

AU - Kumarasamy, N.

AU - Saghayam, S.

AU - Ezhilarasi, C.

AU - Pujari, S.

AU - Joshi, K.

AU - Gaikwad, S.

AU - Chitalikar, A.

AU - Sangle, S.

AU - Mave, V.

AU - Marbaniang, I.

AU - Wirawan, D. N.

AU - Yuliana, F.

AU - Yunihastuti, E.

AU - Imran, D.

AU - Widhani, A.

AU - Tanuma, J.

AU - Oka, S.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

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U2 - 10.1002/jia2.25264

DO - 10.1002/jia2.25264

M3 - Article

VL - 22

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

IS - 3

M1 - e25264

ER -